Facility Evaluation Report

Licensing Program Analyst (LPA) Anna Bueno arrived at the facility for the purpose of following up on open complaint #18-AS-20211223163003 requested records. LPA met with care staff Raymond Munsayac who was informed of the reason for today's visit. Munsayac phoned Licensee Ana Stark who was not present in the facility. Stark informed LPA that they will not be able to provide records to LPA during today's visit as the records were not accessible at this time.

On 12/28/2021, LPA Anna Bueno conducted the initial complaint visit to this facility and requested records.

On 12/29/2021, LPA Bueno sent electronic message to Licensee requesting for records and Licensee responded to LPA that they will work on the request on this day.

On 1/13/2022, LPA Bueno sent an electronic message to Licensee following up on the requested records and Licensee sent a response stating that they will work on this today.

On 2/14/2023, LPA Bueno phoned the Licensee about the open complaint and sent an electronic request for Licensee to forward any submitted to any other LPAs between 1/14/22 through today's notification.

During today's call with Licensee, Licensee was unable to verify if records were sent to another LPA at any time.

LPA Bueno was not able to review and/or receive any records related to this complaint on this visit or at any other time LPA Bueno requested for records. LPA observed Staff 1 (S1) has a criminal background clearance but was not associated to this facility. These pose an immediate health and safety risk to residents in care.

Refer to LIC809-D for deficiencies cited. An exit interview was conducted where this report, LIC809-D, and appeal rights were discussed with and provided to Raymond Munsayac.