Facility Evaluation Report

Licensing Program Anaylts (LPA) Janira Arreola conducted an unannounced visit to the facility LPA initally met with a caregiver Staff, Susan Ouithuyse and spoke with licensee Angela Zhang over the phone who were informed of the purpose of the visit.

LPA met with Staff #1 (S1) upon arrival to the facility. S1 expressed they had just started working at the facility today and were the only staff present at the facility. Additionally on 06/26/2025 the licensee e-mailed the LPA copies of the new administrator Staff #2 (S2), and the new facility manager Staff #3 (S3)'s identification cards. LPA reviewed the Guardian roster of fingerprinted and associated staff and found S1, S2 and S3 have fingerprint clearance but are not associated to the facility. During the time of the visit, S2 the new administrator provided the transfer sheet LIC9182 form for S1. Interview with S2 revealed S2 and S3 have been working at the facility since 06/29/2025. Therefore the facility is being cited for S2 and S3 not being associated to the facility. A civil penalty in the amount of $100 per day for the maximum of (5) days is being issued.

LPA observed (2) residents at the time of the visit. (1) resident is currently bedridden and the facility does not have a bedridden fire clearance. Therefore, the facility is being cited for fire clearance. This violation warrants an immediate $500 civil penalty.