Facility Evaluation Report

This unannounced Case Management – Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 22-AS-20240624114306. LPA met with Administrator (AD) Michelle Song and explained the reason for today’s inspection.

During the course of the investigation, Department staff inspected the facility, interviewed staff, and obtained and reviewed copies of the resident roster and staff roster. Department staff requested information on facility staff who worked at the facility between April 8 and April 12, 2024. On October 22, 2024, Licensee Erik Doan identified Staff #4 (S4), Staff #5 (S5), Staff #6 (S6), and Staff #7 (S7) by first name only, stated they had worked at the facility during this time period, but could not provide any additional identifying information because they no longer work at the facility, and did not maintain staff files for these staff as required. Per Guardian records, S4, S5, and S7 were not background cleared while working at the facility.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421BG. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.