Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct a case management (CM) Plan of Correction POC follow up visit. LPA Tamayo met with facility staff Isikeli Tuikenatabua (S2) and explained the purpose of the visit. Ombusdman Byron Toiliver was also present during this visit.

Upon arrival, LPA Tamayo observed three staff members (S2-S4) present and working. Administrator, Cleopatra Gardiner (S1) was not present during this CM POC follow up visit nor was she at the facility during the last case management visit that was conducted on 6/13/25. on 6/13/25,S2 stated S1 was not working that day due to being out sick. On 6/17/25, LPA Tamayo emailed a copy of the 809-D from CM visit that took place 6/13/25. S1 responded back via email on 6/17/25 stating they will submit the POC by the due date of 6/27/25. No POC verification has not been received by the Regional Office as of today, 6/ 30/ 2025 and POC is overdue. A civil penalty for failure to correct applied due to outstanding plan of correction regarding reporting requirements.

Additionally, a posted LIC 500 Personnel Report dated 6/202/25 indicates S1 is scheduled to work Monday thru Wednesday 7:00 AM-7:00 PM. There is no LIC 308 on file or submitted to Community Care Licensing informing the administrator will be out of the facility and who is designated facility responsibility. The return date for the administrator is unknown by staff (S2, S3, S4 ) and residents (R1, R2, R3. During today’s visit S3 stated has been out of the facility on vacation in New York for about one month. Three residents stated they have not seen S1 for a long time for about “2 months” and do not know where S1 is. Initially, S2 stated S1 has been out on vacation for two weeks, but when LPA Tamayo asked why staff (S3) and 3 residents (R8, R4,and R3) say they have not seen S1 for 1- 2 months.