Correction check·November 6, 2024

On November 6, 2024, Licensing Program Analyst (LPA), Murial Han conducted an unannounced plan of correction visit. Upon entrance, LPA met with caregiver, Linda Mondejar, and explained the purpose of today's visit. Caregiver called the administrator/licensee, Anthony Diaz and informed him of LPA's visit. During the case management visit on 10/23/2024, LPA issued a deficiency under Health and Safety Code 1569.605 as the facility did not have a copy of the current Liability Insurance and the plan of correction was due on 10/25/2024. On 10/28/2024, the facility Licensees submitted a copy of the Worker’s Compensation and Employer’s Liability Policy from Berkshire Hathaway Guard Insurance Companies and on the 1 st page of the liability policy, it stated that the insured period was from May 15, 2024 to May 15, 2025, 12:01AM, the 2 nd page, it indicated that name insured was Westborough Manor and the 3 rd page, it indicated the facility’s address. After viewing the insurance policy, LPA proceeded with calling the insurance company and the insurance retailer (Board Spectrum Insurance) for verification and both confirmed that this policy was not active, it was terminated in 2018-2019 due to non-payment and when it was active, it did not cover this facility and it only covered worker's compensation. They also stated that they did not know how the facility’s address appeared on the 3 rd page of the policy. Due to the above observation and deficiency not corrected as the administrator/licensees was not able to provide a copy of the current general liability insurance, a civil penalty is being assess today in the amount of $100 a day from 10/25/2024- 11/6/2024. A total of civil penalty of $1200 is being assessed today and will continue to accrue until corrected. This report is reviewed and discussed with the caregiver, Linda Mondejar and licensee, Sheila Diaz over the phone. A copy of this report and appeal rights were provided.