Facility Evaluation Report

At approximately 2:10 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced, to conduct a Plan of Correction (POC) visit. On 8/22/2025, LPA issued a citation for a violation of California Code of Regulation section 87405(a) with a plan of correction (POC). The POC called for the Licensee to provide the documents required to make a currently certified administrator the active Administrator of the facility to Community Care Licensing (CCL) by POC due date of 8/25/2025.

As the licensee failed to submit the documents by the POC due date, the facility will be assessed a civil penalty for $100 per day for the period of 8/26/2025 to 08/28/2025 totaling $300. The civil penalty will continue to accrue $100 per day until the deficiency is corrected.

Failure to correct the cited deficiency will result in further civil penalty assessments.

Exit interview conducted. Copy of report, LIC 421FC, provided to Caregiver Buenaflor. Signature on form confirms receipt of documents.