Senior Care Records.

Facility Evaluation Report

Elder Creek Villa III, Saugus05/20/2025Licence 197606229

Capacity6
Census5
Date signed05/20/2025 10:58:48 AM
Name of licensing program analystTuesday Cabiness
Name of licensing program managerTroy Agard
The inspector’s account

Licensing Program Analyst (LPA) Tuesday Cabiness conducted a case management visit to deliver the final complaint investigation report for complaint control number 31-AS-20230517154115. During the visit, LPA met with the facility designee, Allen Rapisura, to explain the reason for the citation issued today.

It was revealed to LPA that the facility staff did not have the required licensing documentation, specifically the LIC 503 Health Screening Report, which is mandatory for the change of administrator. Allen informed LPA that he had undergone a TB test on 05/19/2025, which returned a positive result. He further stated he was scheduled to receive a chest X-ray today to further evaluate the TB test results.

LPA explained that the Health Screening Report is required prior to working in a licensed facility, as stipulated by licensing regulations. Allen reported he was unable to locate his previous health screening and was attempting to obtain a current one. Due to the absence of a valid or current health screening, and the recent positive TB test result, LPA advised that a citation would be issued for noncompliance with licensing requirements. LPA emphasized that this represents a potential health and safety risk to both staff and residents, as well as to LPA during the visit.

LPA instructed Allen not to enter the facility until a negative test result is obtained and submitted to the Department.

An exit interview was conducted, citation issued, appeal rights, and a copy of the report was provided to the facility.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction