Facility Evaluation Report

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced case management visit. LPA identified herself and met with Caregiver, Julita Renojo, to discuss the purpose of the visit.

LPA was at the facility for a complaint investigation, when a violation was observed. LPA conducted a records review of resident and staff files. During the records review, no health screening report was available for Staff 1 (S1). During interview with staff, it was revealed that S1 did not possess a health screening report. LPA Ngallo informed staff that S1 requires a health screening report as they pose a potential health and safety risk to residents in care.

One(1) deficiency was cited per California Code of Regulations, Title 22 (refer to the LIC 809-D page). A Plan of Correction was jointly developed with the licensee.

An exit interview was conducted with Caregiver Julita Renojo and a copy of this report, the LIC 9099-D page, along with the Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit. Their signature below confirms receipt of these documents.