Facility Evaluation Report

This LIC 809 is being amended to generate a new LIC9099 to issue the citation under the correct regulation. The LIC9099 dated on 02/11/2026 will supersede this LIC809.

On 1/28/2026, Licensing Program Analysts (LPAs) Arielle Pascua and Jason Lund arrived unannounced to this facility to conduct a case management visit. LPAs met with Facility Designated Administrator (FDA), Nicolette Taylor and explained the purpose of the visit. There was one other staff member present, Donald Stewart.

Current census was 3. A brief interview with FDA Taylor was conducted.

The purpose of this visit is in response to an appeal determination and criminal record clearance citation.

Deficiency 80019(e)(2) Criminal Record Clearance cited on 10/09/2025 has been changed to reflect 80019(e)(3) Criminal Record Clearance. The Department has reviewed the appeal information, complaint details, and 9099 Licensing Report. It was determined that S1 was in possession of a criminal record clearance. However, a violation still exists for 22 CCR 80019(e)(3) as the facility did not ensure that S1 was associated to the facility at the time of the incident reflected in the 9099 licensing report on 10/09/2025.

As a result, 80019(e)(3) Criminal Record Clearance was observed and cited from the California Code of Regulations, Title 22, and California Health and Safety Code, which can be found on the 809-D Page. LPA Pascua provided a copy of the 809-D page to the facility. Citation 80019(e)(3) Criminal Record Clearance is associated to complaint number 27-AS-20251008133423

An exit interview was conducted, and a copy of this report along with appeal rights was provided to the facility.