Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai and Licensing Program Manager (LPM) Romeo Manzano conducted a case management visit due to additional information received regarding a complaint the Department received 4/4/2023.

During today's visit, LPA and LPMs met with R1 at his/her apartment in the Independent Living Unit. R1 was interviewed and also observed. R1 is dependent on all aspects of his/her daily living except making decision and still able to fed himself/herself. R1 has mild neurocognitve disorder. LPA and LPM obtained R1's records to include Physician Reports, Appraisal/ Needs and Services Plan. LPA and LPM obtained PC 1 and PC2's records available at the facility.

R1 hired a private caregivers 24/7 who provide bath, prepare his/her breakfast, laundry and housekeeping. R1 is not conserved but his/her son has a power of attorney when R1s become incapacitated.

Facility will obtain criminal record clearance and additional paperwork for private caregivers working with R1.

Deficiencies are being cited. See LIC 809-D.

A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500) for staff (S1), $500 ($100 per day x 5 days = $500) for staff (S2), $500 ($100 per day x 5 days = $500) for staff (S3) working at the facility without criminal record clearance, for a total of $1500. Please see LIC 421BG.

Exit interview conducted with Director of Resident Services, Sandra Mirasol. This report was reviewed with and a signed copy was provided. Appeal Rights was provided.