Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA met with Staff Janet Delrosario and the purpose of the inspection was discussed.

During today’s inspection, residents were observed resting in their respective bedrooms. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. Interviews were conducted with one staff and three residents. During their interview, staff stated they are currently paid up to date, facility utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. Individual Jacqueline Tan was observed to also be present and working as the second staff, however, criminal background clearance has yet to be completed: a Deficiency was cited on today’s date.

LPA observed notice of Department commencing proceedings to revoke the license of the facility posted in the entranceway.

Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared and will be re-cited as Licensee did not comply with the POC.

Based on observations made during today’s inspection, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Immediate civil penalty is also being assessed. See the attached LIC421BG. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.