Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada conducted an unannounced case management visit on October 10, 2025. This visit is to confirm ORDER TO LICENSEE/FACILITY FOR IMMEDIATE EXCLUSION FROM FACILITY.

LPA initially met with staff, Irene Hinampas and Eilaisa Niutabua. While waiting for the Administrator to arrive, LPA and staff, Irene, toured the interior of the facility and observed (6) residents to be resting in their private rooms. Also present was staff, Nancy Hubbs and another staff, Cef Olandria, along with a hospice nurse who arrived when LPA arrived was attending to one of the (2) residents currently under hospice care.

The Administrator, Maria Clardy, arrived at 2:00 pm. . LPA stated the purpose of visit and provided the Administrator with a copy of the above order. Facility understands this is an Immediate Exclusion effective October 10, 2025 and (S1) is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove (S1) from any contact with clients and not allow this employee to be physically present in the facility.

Administrator stated (S1) has not worked at the facility since on/around October, 2023.

LPA confirmed that there was a change in Administrator on/around October 2024. LPA to advise the current assigned LPA of this change who can follow up.

Exit interview conducted, a copy of this report provided on this date. A signature on these forms acknowledges receipt of these forms.