Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 5/2/24 at 7:30a. LPA met with Emily Pascua and Randmelvin L Pozon regarding todays visit. During the complaint visit on 5/1/24, LPA provided a LIS Roster and reviewed it with the Licensee. It was discussed that the staff in pending status should not be working until cleared and associated. Licensee stated they were not hiring Staff # 2 (S2) as the finger prints continue to be in pending status. LPA inquired about the staff working during this shift. Both Emily Pascua and Randmelvin L Pozon stated that they are the caregivers working now and the others left. LPA went outside to the front yard and saw 2 caregivers leaving the facility from the side of the home. LPA requested to see their identifications and requested to see the staff files from Emily. Both S1 and S2 stated they did not have identification. LPA requested again some form of identification. They both presented passports. Upon further review, S1 is finger print cleared and associated to the facility. Licensee admitted that although it was stated yesterday that S2 would not be hired because of pending status, S2 has worked in the facility for 1 year. This information was confirmed by S2 during this visit. Community Care Licensing does not have any previous staff roster printouts which contained S2's name. Licensee stated they do not have previous rosters which are shredded once updated. S2 provided copies of live scan and finger print documents dating back to 2023 which indicate she was cleared. Licensee has submitted an email to the Guardian Department to inquire about the pending status.

A review of the facility files for S1 and S2, they were observed to be either missing or incomplete. Both did not include pertinent Licensing forms. LPA provided a copy of the LIC311F Records to be maintained at the facility-Residential Care Facility for the Elderly.

Civil Penalty assessed in the amount of $500.00. (See LIC421IM) Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; additional civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided.