Facility Evaluation Report

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - deficiencies visit in conjunction with a complaint investigation visit conducted on this day. LPA met with Randy Bandong and explained the purpose of today's visit.

During the course of complaint #14-AS-20220817100625 the following attached deficiencies were discovered during the course of the complaint investigation. In summary they are:

Type A: Staff S1, S2, and S3 are not associated to the facility - $100 for each staff person not associated x 5 days = $1500

Type A: Staff S1 is not fingerprinted and not associated to facility - $100 a day x 5 days = $500

Type A: Incident reporting. The licensee/administrator failed to complete incident reports.

Citations are issued on the attached LIC809D. Civil penalties are assessed on this day in the above listed amounts on attached LIC421IM.