Facility Evaluation Report

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required annual inspection and in conjunction conducted this case management visit at the facility. LPA Lopez identified herself and was granted entry by Erlinda Samiano, Assistant Administrator/Caregiver. LPA stated the purpose of the visit and reviewed the basic elements of the visit with Assistant Administrator Samiano and Licensee Loida Monton, who later arrived and joined the visit.

During today’s visit, LPA provided the Licensee Monton consultation and provided additional information regarding the Department’s website, Records to be Maintained at the Facility – Adult Residential (LIC 311C), Changes to Administrator Certification Training Requirements (PIN 23-14-CCLD), Criminal Background Clearance Transfer Request (LIC9182) and Criminal Record Exemption Transfer Request (LIC 9188) Form Updates (PIN 23-08-CCLD), Residential Care Facilities for the Elderly Reference Guide to Administrator, Staff, and Volunteer Training Requirements (PIN 23-16-ASC), and Revised Infection Control Regulations and Permanent Adoption (PIN 23-12-ASC).

No deficiencies were observed or cited during this case management visit. An exit interview was conducted with Licensee Monton and a copy of this report and Licensee/Appeal Rights (LIC 9058 3/22) were provided to the Licensee at the conclusion of the visit. The signature below confirms the documents were received.