Facility Evaluation Report

Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced Required 1 – Year Visit. The facility file was reviewed prior to the visit. LPA met with Celia Garcia and we discussed the purpose of the visit. All staff present do not have a current criminal record clearance.

LPA conducted a tour of the facility, both inside and outside. In accordance with the Department’s Infection Control, LPA evaluated and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment.

During today's visit, LPA observed Staff 1 (see LIC811 Confidential Names List) working at the facility. S1 does have a criminal record exemption, however, it is not associated to the facility.

The Licensee arrived during the visit and stated that she was unaware S1's criminal record exemption has not been properly transferred to the facility. The Licensee acknowledged S1 cannot be at the facility until S1 is properly associated to the facility. In the meantime, the Licensee will be the staff on site. Prior to delivering this report, LPA observed S1 leave the facility's premises an immediate civil penalty of $500 is charged on this date.

An exit interview was conducted. The Licensee was provided a copy of their appeal rights (LIC9058 03/22), along with a copy of this report.