Facility Evaluation Report

On 9/26/2024 - at 2:28 p.m. LPA Partoza conducted an unannounced visit to amend LIC 809C to add the PIN 19-01-CCLD Communication With Complainants and 809D to reflect the deficiency statement of *87355 (e)(1), obtain the signature which was both not captured during visit on 9/15/2024.

On 9/15/2024 - at 2:45 p.m. LPA Partoza conducted an unannounced visit to amend the case management report to reflect the series of events and correct the citation that was issued at the time of the visit on 9/13/2024.

At 3:45 p.m. LPA encountered a technical issue and have recreated this case management to correct the LIC 421BG. The previous LIC 421BG has the incorrect individual's name. In addition the LIC 809 D has the incorrect deficient statement and is missing a citation.

On 9/13/2024, Licensing Program Analysts (LPAs) Maria (Mita) Partoza and Marcella Tarin, conducted an unannounced case management - deficiency visit and met with licensees (LICs) Ramiro Custodio and Merclo Garcia and stated the purpose of the visit.

On 9/13/2024, at 11:30 a.m. LPAs Partoza and Tarin interviewed the licensee and inquired about staff who are currently working at the facility. LIC stated that the facility currently has 5 staff and 1 out of 5 lives in the facility since July 1, 2024 and did not have a fingerprint/criminal record clearance. LIC stated that staff 1 (S1) is a family and helps with care and supervision of the residents such as but not limited to activity of daily living. At the time of the visit S1 was not present and was asked by the LIC to obtain a livescan. LIC stated that S1 have not been trained for the care and supervision of the resident which is a requirement for Residential Care Facility for the Elderly (RCFE) staff.