Facility Evaluation Report

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit regarding complaint 18-AS-20231115154544. LPA was granted entry and met with House Manager Juan Carlos Ponce De Leon.

LPA conducted a health and safety check and toured the home, conducted interviews, and record review.

LPA conducted a health and safety check and found based on record review, observations, and interviews, that Staff Two (S2) were not associated to work at this facility. Civil penalties will be issued.

LPA's interview with Staff One (S1) and Administrator Jim Morrison revealed Resident One (R1) had passed away on 11/04/2023. Licensee did not report R1's death to the department per Title 22 regulations and a deficiency will be issued along with a plan of correction. The department's last incident report or death report that was received from the licensee was on 07/21/2021.

An exit interview was conducted where a copy of this report, deficiency page, and appeal rights was provided to House Manager Juan Carlos Ponce De Leon.