Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a unannounced Case Management Visit-Deficiency on 04/12/2025, stemming from subsequent complaint investigation visit on 04/12/2025. LPA was greeted by Ernest Sumaydeng and LPA explained the purpose of the visit.

LPA Ramirez conducted a personnel record inspection of Staff#1 (S1) personnel file stemming from complaint investigation Control Number 28-AS-20241016225924. These records revealed S1 began their employment with the facility on 12/12/2023. Review of facility staff criminal record clearance revealed S1 is not associated to the facility by criminal record clearance transfer as required by 80019(e)(3) Criminal Record Clearance- (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 80019(f). Based on records reviewed, LPA Ramirez will issue a type A deficiency and an immediate $500 civil penalty. Administrator agreed to update staff association on Guardian to reflect staff currently working at the facility by 05/01/2025.

LPA Ramirez could not locate S1's criminal record clearance in S1's personnel file as required by 80019(j) Criminal Record Clearance- (j) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees in the individual's personnel file as required in Section 80066. LPA Ramirez will issue type A deficiency based on record review.

Two (2) violations and a $500 civil penalty was assessed during this case management visit. Exit interview was conducted via telephone with Assistant Administrator Gloria Gibson. A copy of this report, 809-D, LIC421IM, and appeals rights was provided via email