Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert arrived unannounced to conduct a Case Management Deficiencies Visit. LPA was greeted and granted entry by Staff #1 (S1) at 11am. LPA explained the purpose of the visit with staff and spoke to Licensee (LE) Maricel Nepomuceno over the phone.

The facility currently has five residents in care. LPA interviewed two of five alert residents regarding the care provided at the facility and spoke to two of two staff members regarding care being given. Two of two staff members confirmed they were not paid on 7/22/2026 for the pay period of 7/1-7/15/2026 and one of one staff had additional back pay owed. A penalty, LIC 421FC, will be assessed for finances in the amount of $100 per day X 23 days for the amount of $2300. LPA spoke with Licensee (LE) regarding staff not being paid and LE stated staff were advised that accounts had fraudulent activity and would be restored within ten business days.

One of two staff members at the facility is background cleared but is not associated to the facility. A civil penalty, LIC421IM, will be given for the amount of $500. LE was advised to associate the staff member to the facility location by end of visit. The Department did not receive notification that there is currently not an Administrator at this location. A deficiency will be given and LE will designate an Administrator to the facility by Plan of Correction date of 7/31/2026. Total amount assessed during today's visit is $2800.

The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Staff #1 (S1) and a copy of this report was given to the facility along with a copy of the LIC 809-D, LIC421FC, LIC421IM and Appeal Rights.