Follow-up on corrections·November 6, 2024

On November 6, 2024, Licensing Program Analyst (LPA), Murial Han conducted an case management visit to follow up on a case management visit on 10/23/2024. LPA met with caregiver, Linda Mondejar who called the administrator/licensee Anthony Diaz and explained the purpose of today'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 at 10:54am, the facility Licensees submitted a copy of a one page Worker’s Compensation and Employer’s Liability Insurance from the Berkshire Hathaway Guard Insurance Companies and initially LPA observed the facility was not listed under named insured. LPA informed the Licensees of the observation, and a few hours later at 1:16PM, the Licensee submitted an addendum of 2 more pages including the name insured- Westborough Manor on the 2nd page and facility's address on the 3rd page. After viewing the insurance policy, LPA proceed with calling the insurance company and the insurance retailer (Board Spectrum Insurance) for verification and they confirmed that this policy was for Worker's Compensation and it did not cover for General Liability Insurance and that the policy was terminated in 2018-2019 due to non-payment. In addition, they stated that when the policy was active, it did not include this facility and they did not know how the facility’s address appeared on policy. Based on observation and record review, the administrator/licensees provided a copy of the expired worker’s compensation insurance policy and not the general liability insurance and the policy was altered as the insurance company confirmed that this facility was not included on the policy yet it appeared on the policy that was provided by the licensees. In addition, the administrator did not conform to the laws, rules, and regulations as the administrator did not ensure the facility has an active Liability Insurance Policy. Deficient is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with the caregiver and administrator/licensee over the phone. A copy of this report and the Appeal Rights are provided.