Facility Evaluation Report

On 05/07/2024 at 01:30 PM, Licensing Program Analyst (LPAs) Melody Brown and Sarina Ramirez met with Licensee/Administrator Patsara Chantharaseth to initiate Case Management Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation.

During the facility visit today, 05/07/2024, Licensing Program Analysts (LPA) Melody Brown and Sarina Ramirez requested a copy of the facility’s Personnel Report (LIC500) and LPAs Brown and Ramirez reviewed document received and cross reference Guardian database and observed that Staff #2 (S), and Staff #3 (S3) have their background clearance, but they were not associated to the facility as their criminal background clearance was not transferred to the facility. Moreover, during the facility visit today, 05/07/2024, LPAs Brown and Ramirez informed Licensee/Administrator Chantharaseth that deficiency will be issued and Civil Penalties were assessed during the facility visit today with the amount of $300.00 for S2 and $200.00 for S3 and will continue to be assessed of $100.00 per day per citation until corrected for not transferring criminal record clearance for S2 and S3 for not S2 and S3 criminal background clearance to the facility.

In addition, during the tour of the facility, LPAs Brown and Ramirez observed two (2) beds set-up in the common area of the home. LPAs Brown and Ramirez explained to Licensee/Administrator Chantharaseth that no room commonly used for other purposes shall be used as sleeping room. Deficiency will be issued.

Furthermore, LPAs Brown and Ramirez observed that no staff's schedule to work at night shift and per documents review, the facility has a dementia resident and LPAs observed no night supervision at the facility. Deficiency will be issued.

An exit interview was conducted where this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Patsara Chantharaseth.