Facility Evaluation Report

On 06/27/2023, LPA Monter and LPM Manzano conducted a case management visit – deficiencies visit. LPAs met with Administrator, Fred Ogle

On 5/10/2023, the facility was issued the following citations with a POC date 05/17/2023. On 05/17/2023, the licensee requested POC extension from 05/17/2023 to 06/17/2023. As of today’s visit, the licensee has not submitted or corrected citations resulting in civil penalties.

The following deficiencies during an annual inspection on 05/10/2023 are as follows:

• 80066(a)(12)(B)1 , Personnel Records (Type B), Issued initial Civil Penalty (CP) of $100.00 beginning 6/17 and will continue to accrue until corrected.

• Health and safety code 1565(c), Issued initial CP of $100.00 beginning 6/17 and will continue to accrue until corrected.

• Title 22, Code Section 85070(a)(3) , Client records/ Type B. Issued initial CP of $100.00 beginning 6/17 and will continue to accrue until corrected.

• Title 22, Code Section 80066(a)(11), Personnel Records/Type B . CP will be assessed from 6/17 until corrected.

The following deficiency issued because of a complaint investigation on 06/13/2023 as follows:

• Title 22, Code section 80072 (a)(2) Personal Rights, Type A Issued CP $1000.00 from 6/17 to 6/26/2023 and will continue to accrue. CLEARED DURING VISIT.

CP issued today for the maximum of $300. LPA informed licensee that if the 4 deficiencies are not corrected, civil penalty will continue to accrue until corrected.

LPA discussed about the importance of Plan of Correction. License agreed and understood.