Facility Evaluation Report

At approximately 8:35 AM, Licensing Program Analyst (LPA) Robert Frank, arrived unannounced to conduct a Case Management Visit and met with Administrator, Robertson Cirineo. The purpose of the visit is to deliver an Order for an Immediate Exclusion for staff member S1 from all facilities.

Per the Immediate Exclusion notice, Staff Member S1 cannot be allowed to work, be present and/or live in a Community Care Licensing (CCL) licensed facility, or have contact with residents in any residential facility or child day care facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with residents and not allow this employee to be physically present in the facility.

Administrator informed LPA that S1 has not worked at the facility for two (2) years. Administrator stated they understood the notice.

Exit interview conducted. Copy of report and LIC-811 Confidential Names, discussed and provided to Administrator Cirineo. Signature on form confirms receipt of documents.