Facility Evaluation Report

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced Case Management-Incident visit on 07/24/2026 regarding reported incidents involving Resident 1 (R1). LPA met with two staff. No residents were present at the facility at the time of the visit. Administrator/Licensee (ADM/LIC) Johann De Guzman arrived at the facility but left at 9:15 a.m. due to a prior commitment.

On 05/06/2026, the Department received an incident report regarding Staff 1 (S1) and Staff 2 (S2). The incident report documented that 4 facility staff witnessed S1 and S2 physically harm R1 on multiple occasions. The reported incidents occurred on 04/26/2026, 04/27/2026, 04/28/2026, and 04/30/2026.

On 05/07/2026, LPA conducted an unannounced Case Management-Incident visit and interviewed Staff 3 (S3), Staff 4 (S4), and Staff 5 (S5). Staff 6 (S6) was not present at the facility during the visit. LPA also obtained staff declarations of S3, S4, S5, and S6, incident reports, SOC 341 reports, and the facility’s employee roster.

During the visit on 07/24/2026, LPA asked ADM/LIC when facility staff reported the incidents. ADM/LIC stated that staff reported the incidents to ADM/LIC on either 04/29/26 or 04/30/26 and that the facility submitted the incident report to Community Care Licensing Division (CCLD) on 05/06/2026.

The incident report documented incidents involving S1 on 04/27/2026 and 04/28/2026. S3, S4 and S6 declarations documented that on 04/27/2026, S1 struck R1’s arm with a slipper and slapped R1’s face with a sandal and further stated that on 04/28/2026, S1 slapped R1’s face and kicked R1's stomach.