Facility Evaluation Report

This is an amended report. The administrator did not have signature on the original report.

On 9/12/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted a unannounced case management - deficiency visit observed during an unrelated complaint visit. LPA met with Administrator Teresita Bautista (S1) and and three staff (S2-S4).

1) Based on LPA's interview with S4, he began working in this facility on 8/22/2022 on a part-time basis. S4 stated he works on Mondays and Tuesdays, 6:00 am:7:00 pm. S4 stated he is a caregiver and he provides ADL care to residents. During LPA's interview with Staff 2, S4 has a background clearance under a different facility. S4 stated he has not submitted a transfer of clearance for S4 to CCLD.

2) During LPA's tour of the facility, LPA observed the garage is cluttered with boxes, frame frame, used wheelchairs, oxygen tank and other miscellaneous items.

A technical violation is used to licensee.

Deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. A civil penalty of $500 was assessed.

Failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided to Administrator Teresita Bautista.