Facility Evaluation Report

Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to conduct an annual required licensing inspection and in conjunction conducted a case management visit to the facility and gave additional guidance. LPA identified herself and was granted entry by Johnpiolo Mercado, caregiver. LPA met with Erlinda Mascardo, Licensee, who later arrived at the facility and discussed the purpose of today’s visit.

During today’s visit, LPA toured the facility accompanied by caregiver Mercado. LPA briefly went over Title 22, Division 6, Chapter 8, Section 80061 Reporting Requirements, with Licensee Mascardo. LPA provided Licensee Mascardo guidance on Records to be Maintained at the Facility – Adult Residential (LIC311C) and provided a copy of the LIC311C form. Based on today’s inspection no deficiencies were observed.

An exit interview was conducted with Licensee Mascardo. A copy of this report, along with the Licensee Rights (03/22) was provided to Licensee Mascardo at the conclusion of the visit. The signature below serves as confirmation of receipt of these documents.