Facility Evaluation Report

On today’s date, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a case management visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility. Administrator (AD) Rosendo "Carla" Miranda spoke with LPA via telephone and granted permission for Caregiver Cecille Peterson to sign the report at exit.

During the visit, LPA requested the following documentation from facility staff by phone and via email:

- Proof of rent payments for October, November, December 2025

- Payroll records for October, November, December 2025

- Grocery receipts for October, November, December 2025

- Utility bills (water, gas and electricity) for October, November, December 2025

LPA toured the facility with staff and observed no health and safety issues. Property utilities are working, including electricity, gas, and water. Perishable and non-perishable food supply was observed adequately stocked at time of visit. It was reported that staff were not paid in a timely manner. Interviews were conducted during today’s visit and six out of six staff confirmed staff were not paid on time. All staff stated paychecks were scheduled to be paid on the 7th day of the month and staff did not receive payment as of today's date. S5 & S6 stated all facility staff were not paid on 1/7/26 and will receive the remaining half of their paycheck for 12/22/25, as well as their full paycheck for 1/7/25 on 1/9/26.

Based on the observations, interviews, and records reviewed during the present visit, the deficiency cited on 12/31/25 remains uncorrected as the facility did not complete the plan of correction by the due date.

CIVIL PENALTY ASSESSED for failure to correct.

An exit interview was conducted and a copy of this report, LIC809-D, LIC421FC, and appeal rights were provided to a facility staff.