Facility Evaluation Report

An office visit was scheduled on this day with Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst (LPA) Rose Ruppert for the purposes of delivering findings into complaint control number 22-AS-20230927113557. LPA met with Licensees Maricel Nepumuceno, Allen Medina and Keak Vongphakdy. During the course of the investigation, the following deficiencies were observed.

During the course of the investigation, it was determined that the facility does not have sufficient resources to meet operating costs for care of residents. Furthermore, during the investigation the Licensee was asked to provide the Department requested documents by Friday September 6, 2024. After failing to meet the deadline, an extension was granted and the requested financial documents were to be provided by COB September 26, 2024. The Licensee failed to provide the requested documents by the extended deadline and later advised they were on jury duty and would work on providing the requested information that day. No plan was put in place at the time the Licensee was unavailable to ensure supervision over the affairs of the licensed facility in an effort to conform with the Department’s authority to audit and inspect records requested. As of Tuesday October 8, 2024, the documents had still not been received. After several more requests, the full requested documentation was not received as of Thursday October 17, 2024. To date, requested documents such as bills for July and August of 2023 & LIC403A Balance Sheet Supplemental Schedule.

The following is being cited per Title 22.

An exit interview was conducted with Maricel Nepumuceno, Allen Medina and Keak Vongphakdy. and a copy of this report, LIC809-D, and appeal rights was provided at the time of exit.