Facility Evaluation Report

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate complaint #18-AS-20230309085709. LPA met with staff, Levina Dubose who was informed of the purpose of the visit.

During the process of investigating the complaint, LPA found the following deficiency:

LPA reviewed the facility staff roster and compared it to the Guardian Roster. It was found that Staff #1 (S1) was not on the Guardian roster. LPA requested clearance information for the staff. LPA verified clearance with the department but, staff was unable to provide documentation showing a transfer request was sent to the department. Therefore, the facility will receive a Type A deficiency for facility staff not being transfer. The facility will be assessed a civil penalty of $500.

An exit interview was conducted with staff, Levina Dubose who was provided this report, along with LIC809-D page, and appeal rights.