Facility Evaluation Report

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted a case management visit for an exemption request for staff (S1) that cannot be completed due to incomplete information and incorrect form used. LPA met with Administrator (ADM) Elizabeth Bautista and stated the purpose of the visit.

The facility is a Residential Care Facility for the Elderly (RCFE) that serves individuals who are age 60 and over, approved for 6 non-ambulatory of which 1 may be bedridden and hospice waiver for 4.

LPA observed 5 out of 6 residents and 2 staff (S2 and S3), at the facility. 1 Out of 5 resident was in the living room watching TV, 1 Out of 5 is under hospice care, 3 out of 5 are in bed and resting. 1 out of 5 is out of the facility for medical appointment.

LPA checked Guardian S2 and S3 are both associated with the facility. LPA interviewed S2 and S3. and 4 out of 5 residents (R1 to R4).

LPA reviewed staff record and found that S1 worked at the facility since 5/7/2023 and no exemption transfer request was submitted to CDSS CPMB (Care Provider Management Branch).

Based on interview with S1, S2, and residents (R2 and R5) S1 works at the facility and provides care to residents. ADM stated that S1 has been working as a part time for the facility since 5/7/2023, and had an exemption from the old license that was closed on 8/23/2022. The exemption transfer approval for S1 was not transferred to the new license. ADM stated that he/she assumed that the exemption transfer approval of S1 from the old license is still effective after the closure of the old license.