Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility, to conduct case management. LPA met with AD Abdul Arastoo and stated the purpose of this visit.

During the investigation of Complaint No. 22-AS-20210615102934 received against, per interviews and file review, Staff 1 (S1) and Staff 2 (S2) were not associated to the facility; and were not part of the Licensing Information System Personnel Summary Report printed on June 15,2021 for the facility.

On October 5, 2021, LPA Marin received a email from AD Arastoo providing documentation that the facility submitted a clearance transfer request For Staff 2 (S2). The document had a date stamped that it was received by Community Care Licensing Division (CCLD) last May 18, 2018. Facility was not able to provide supporting document on the clearance transfer request for Staff 1.

For this visit, the deficiency had been observed and a citation was issued per Title 22 Division 6 of the California Code of Regulations.

LPA Marin conducted an exit interview with AD Arastoo. LPA discussed the deficiency, citation, and appeal rights. LPA left copies of this report, LIC 809 (Deficiency), appeal rights and cited regulations in the facility.