Routine inspection·June 6, 2022

Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with staff Carel Velarde and stated the purpose of this visit. LPA Tapia reviewed Facility Personnel Report and noticed that staff Carel Velarde is not associated with the facility. LPA Tapia contacted Administrator to informed them that all staff need to be associated to the facility. Administrator stated he is out of town and could not come to the inspection. LPA Tapia reminded Administrator of their responsibilities as an Administrator. Administrator filled out LIC 9182 for Carel Velarde and staff filled out LIC 508. Facility was unable to associate staff Carel Velarde to the facility. Administrator filled out LIC 9182 for Edita Tersoro and was able to associate Edita Tersoro to facility. LPA Tapia observed Carel Velarde leave the facility prior to LPA leaving the facility. The facility is licensed for six non-ambulatory one of which may be bedridden and a hospice waiver for six. This facility offers Residential Care for the Elderly and Dementia. For this visit, a deficiency was noted in areas observed and a Civil Penalty was issued. Due to time constraints LPA will return at a later date. LPA Tapia conducted an exit interview with staff and copy of this report was explained and left at the facility.