Facility Evaluation Report

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility and observed the following deficiencies. LPA met with S1 and Licensee and explained the purpose of the visit.

At entrance, S1 opened the door for LPA. When asked how long has S1 been working at the facility S1 stated "about two months". Based on LIC 500 provided on October 31, 2024 dated October 29, 2024, it listed S1 as a caregiver.

Based on LPA's file review of Guardian, S1 does not have a criminal clearance association to the facility. Based on file review of LPA's emails, it revealed Licensee had sent an email to CDSS CCL SAC ACS TRANSFER REQUEST corresponding LPA on September 6, 2024, Licensee sent a photo of S1's DOJ Applicant Fingerprint Response.

File review observed on September 9, 2024 LPA responded "Please send all the required documents in order for the regional office to assist with the association." File review, there was no additional response from Licensee. Criminal Clearance Transfer Request LIC 9182 and S1's driver license/proof of identification for S1 has not been received by the Department.

Note: facility has been cited for Criminal Record Clearance violation during LPA's visits conducted on 7/18/2024 and 8/20/2024.

LPA provid ed a copy of the following Title 22 regulations for Licensee to review: