Facility Evaluation Report

Licensing Program Analyst (LPA), Adrian Mangina conducted a case management-Deficiencies visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver, Julita Renojo.

LPA was at the facility for another matter and observed that resident Maria Theresa Renojo, a volunteer caregiver has lived in the home since 2014. Ms. Renojo is fingerprint cleared but not associated to the facility as required.

LPA explained the citation and civil penalties for violation of Title 22, Division 6, Article 3, Section 80019(e)(3) Criminal Record Clearance to Caregiver Julita Renojo.

An exit interview was conducted with Caregiver Julita Renojo who was provided a copy of the Licensee and Appeal Rights (LIC9058 01/16), along with a copy of this report. Ms. Renojo's signature below confirms agreement to receipt of documents.