Facility Evaluation Report

At approximately 9:30 AM, Licensing Program Analysts (LPAs) Julie Florio and Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and were greeted by Staff 1 (S1). Administrator, Luningning "Nina" Sikat, was contacted and informed LPAs that Staff 2 (S2) would come to the facility to conduct the inspection with LPAs. S2 arrived at approximately 10:30 am. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. All residents were present during today's inspection. Facility has a hospice waiver for three (3) and is approved for six (6) non-ambulatory residents.

LPAs were informed by a resident that another staff person was present in the facility. Subsequently, LPAs discovered Staff 3 (S3) located in the designated staff bedroom and were informed that S3 has been working in the facility for six (6) days without a criminal record clearance or having been associated to the facility in the guardian system as required per Title 22 regulation, (see LIC809D and LIC421BG).

LPAs will return at a later date to complete the annual inspection.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

**An Immediate Civil Penalty in the total amount of $500 is being assessed for the observed uncleared staff present, working, and sleeping in facility, which is a criminal record clearance violation and immediate health, safety, and/or personal rights violation to persons in care, (see LIC421BG).**

Appeal rights were given. Exit interview conducted with S2 whose signature on form confirms receipt.