Facility Evaluation Report

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced Case Management visit to deliver an “Order to Licensee/Facility of Immediate Exclusion from Facility” for staff #1 (S1 – see Confidential Names List). LPA Lopez identified herself and was granted entry by caregiver Rogelio Matic. LPA stated the purpose of the visit and met with caregiver Matic and Licensee Gino Uy, who later arrived and joined the visit. Administrator Paul C. Diwa was phoned in via FaceTime with the Licensee Uy's phone per their request.

The Department of Social Services, Community Care Licensing Division, orders Dignity Homecare LLC, to remove S1 from any contact with residents or presence of S1 in all facilities associated. This exclusion letter is in result of an investigation by the California Department of Social Services, a complaint of conduct inimical has been found to be substantiated against an employee, by the name of S1. The Department has determined that continued or future contact with residents or presence in any child day care or residential facility licensed by the California Department of Social Services constitutes a threat to the health and safety of the residents in care.

During the visit, LPA confirmed that S1 was present at the facility. LPA provided S1 their exclusion letter and informed them it was an immediate exclusion. S1 left the facility premise prior to LPA’s departure. LPA spoke with licensee Uy and administrator Diwa and provided them with their exclusion letter. Administrator informed LPA they did have another caregiver to assist with the care needs of the residents in care.

An exit interview was conducted with Licensee Gino Uy, to whom a copy of this report, exclusion letter, LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 01/16) were provided. The signature below confirms the documents were received.