Facility Evaluation Report

On 06/29/2023, Licensing Program Analysts (LPAs) Arielle Pascua, Christina Valerio and Arvin Villaneuva arrived unannounced to this facility to conduct as Plan of Correction (POC) visit. LPAs were greeted by staff member, Alma Moyamoy and asked to call the Facility Designated Administrator, Julian Hawes to let him know that CCL was present at this time. Shortly after, LPA Pascua spoke to staff member, Andrea Rush and informed LPA Pascua that she was going to a manager meeting. LPA Pascua asked who she may proceed the visit with. SM Rush stated she would inform the Facility Designated Administrator, Julian Hawes and inform me shortly. LPA Pascua was informed that FDA Hawes could not make the visit and asked LPAs to continue the visit with SM Rush. Current Census was 4. 3 out of 4 residents are out at their respective day programs.

Upon arrival, LPAs observed staff member, Alma Moyamoy, take a padlock off the refrigerator door. LPA Pascua asked why the refrigerator door was locked, SM Moyamoy stated that she put it on there. LPA Pascua reminded SM Moyamoy that a lock is not allowed on the door.LPA Pascua also observed the pantry to be locked and made inaccessible to the residents.

The purpose of this visit was to follow up on the prior deficiencies and plan of corrections that were due on 06/16/2023 from a prior case management visit conducted on 06/15/2023.

As of the date of this visit, 06/29/2023, the department had not received any forms or documents to support the plan of the correction and has not been completed by this facility and its designated Administrator at this time.

A civil penalty in the amount of $1,200 was assessed for violations of Section 80044(c) for the time between 06/17/2023-06/29/2023. This civil penalty was due to failure to correct the deficiency by the Plan of Correction date. The Facility was informed that the civil penalty will continue to accrue $100 per day per violation until the deficiency is corrected.

The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to the facility via email and an electronic email read receipt confirms receiving these documents.