Emerald Residential Care Home

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds, consisting of 6 private client bedrooms--2 of which have exit doors to outside, and 3 of which have private full bathrooms. There is a common bathroom, living room, dining room, and kitchen. Backyard is level and fenced, and there is a detached storage shed. There are 3 staff and 4 clients present. A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature is tested at 115 degrees in common bathroom. Washer and dryer are located in detached 2-car garage. Food supply and first-aid kit are inspected. All client files are reviewed, including Centrally Stored Medications Records and clients' cash handling records. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as other staff records. Isabelle Gil is a certified RCFE administrator (x 6/26) that oversees facility operations, as well as assistant administrators Michelle Carino-Becerra (x 5/26) and Kristine Tan (x 12/27) The following forms/information are requested to be completed and returned to CCL by 3/11/26: • LIC 400 Affidavit regarding Client Cash Resources • LIC 308 Designation of Administrative Responsibility Updated Personnel Report (LIC500), proof of current liability insurance and surety bonding are given to LPA. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. See also Technical Advisory Notes--3 pages.the state’s words, verbatim · CDSS document, Feb 25, 2026

Type of visit: POC

LPA Jeung met with administrator and staff to monitor corrections made as per citations and civil penalties issued on 2/25/25, 2/27/25, and 3/4/25. Proof of corrections was submitted to CCLD on 3/10/25. The following corrections have been made: Section 87303(e)(2) Maintenance and Operation - Hot water temperature tested at 117 degrees in client bathroom -- Civil penalty of $100/day ceases as of 3/10/25 -- Civil penalty of $500 is assessed today for period 3/5/25 - 3/9/25 at $100/day Section 87217(g)(1) Safeguards for Resident Cash - Records for clients' P & I monies has been modified and is current and accurate -- Civil penalty of $100/day ceases as of 3/10/25 -- Civil penalty of $500 is assessed today for period 3/4/25 - 3/9/25 Health and Safety Code 1569.695 - Copies of emergency disaster drills dated 1/2024, 7/2024, 10/24/ 1/2025 submitted to CCLD -- Civil penalty of $100/day ceases as of 3/10/25 -- Civil penalty of $500 is assessed today for period 3/4/25 - 3/9/25 *****Due to technical difficulties, this Facility Evaluation Report and associated 3 Civil Penalty Assessments cannot be printed. LPA to deliver reports at a later date or via email.****the state’s words, verbatim · CDSS document, Mar 26, 2025

Type of visit: Case Management - Deficiencies

During plan of correction visit, LPA Jeung observed deficiency of the California Code of Regulations, Title 22. Citation appears on a following page. Information about safeguarding of clients' cash resources is provided to administrator. In addition, LIC200 is corrected in LPA's presence to accurately reflect requested change from non-ambulatory to one bedridden client. Licensee is also requested to submit lease addendum--signed and dated by landlord. Acknowledgement of a correction is issued--1 page. .the state’s words, verbatim · CDSS document, Mar 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(13) · Plan of correction due date: Mar 4, 2025

PERSONAL RIGHTS Residents in all RCFEs shall have the right... to have access to individual storage space for private use. This requirement is not met, as personal belongings of staff--clothing, suitcases, purse, plastic bags--are stored in room of client #4, adjacent to dining room. Licensee failed to ensure that clients have their own personal storage space, which poses an immediate personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Mar 4, 2025

Plan of correction: Personal items of staff were removed from room #5 in LPA's presence. Deficiency corrected and cleared

Type of visit: POC

LPA Jeung monitored corrections of deficiencies cited on 2/27/25--for which plans/proof of corrections were due on 2/28/25--and 2/25/25--for which civil penalties were assessed. The following deficiency, which was cited on 2/25/25, still exists: Section 87303(e)(2) Maintenance and Operation - Hot water temperature tested at 125 degrees in client bathroom -- Civil penalty of $100/day continues to accrue daily until deficiency is corrected and CCLD is notified -- Civil penalty of $600 is assessed today for period 2/27/25 - 3/4/25 The following deficiencies, which were cited on 2/27/25, still exist: Section 87217(g)(1) Safeguards for Resident Cash - Plan of correction for plan to maintain clients' P & I monies current and accurate was not submitted -- Civil penalty of $100 is assessed today, and will continue to be assessed daily until deficiency is corrected and CCLD is notified -- Civil penalty of $400 is assessed today for period 3/1/25 - 3/4/25 Health and Safety Code 1569.695 - Plan of correction for implementation of quarterly emergency disaster drills was not submitted -- Civil penalty of $100 is assessed today, and will continue to be assessed daily until deficiency is corrected and CCLD is notified -- Civil penalty of $400 is assessed today for period 3/1/25 - 3/4/25the state’s words, verbatim · CDSS document, Mar 4, 2025

Type of visit: POC

LPA Jeung reviewed corrections of deficiencies cited on 2/25/25 during annual inspection. Acknowledgement of corrections made on 2/26/25 are given to Ms. Gil--2 pages. The following Type A deficiencies still exist, as corrections were not made by 2/26/25: Section 87303(e)(2) Maintenance and Operation - Hot water temperature tested at 102 degrees -- Civil penalty of $100 is assessed today for failure to correct deficiency by 2/26/25 --- Civil penalty of $100/day to be assessed until deficiency is corrected and CCLD is notified Section 87468.1(a)(1) Personal Rights - Video baby monitors are still in use upon LPA's arrival today - Video cameras and baby monitors are removed in LPA's presence -- Civil penalty of $100 is assessed today for failure to correct deficiency by 2/26/25the state’s words, verbatim · CDSS document, Feb 27, 2025

Type of visit: Case Management - Annual Continuation

To complete annual inspection of 2/25/25, LPA Jeung reviewed clients' Centrally Stored Medication Records and personal and incidental money handling for 3 clients. Deficiencies of the California Code of Regulations, Title 22 are cited on a following page.the state’s words, verbatim · CDSS document, Feb 27, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Mar 7, 2025

GENERAL FOOD SERVICE Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met, as there are no canned fruits maintained and minimal fresh vegetables for 2 day supply. Licensee failed to maintain 7-day supply of canned food and 2-day supply of fresh vegetables, which poses a potential health and safety risk to clients in care. Minimal amount of broccoli crowns and lettuce and frozen mixed vegetables observed.the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Proof of correction to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Mar 7, 2025

MEDICAL ASSESSMENT Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a MD assessment, signed by a licensed medical professional... and made within the last year, to be kept in the resident's record. This requirement is not met, as there are no MD reports and/or TB test results on file for 3 out of 5 clients. Licensee failed to ensure that MD reports and/or TB test results are maintained for all clients, which poses a potential health, safety or personal rights risk. No MD report/TB test results for C1, C3,C5.the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Copies of MD reports and/or TB test results for clients #1, #3, #5 to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Mar 7, 2025

RESIDENT RECORDS The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met, as 1 out of 5 client file is not available for review. Licensee failed to ensure that all client records are made available for licensing agency review, which poses a potential health, safety or personal rights risk to clients in care. File for client #5 is not available.the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Plan of correction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463 · Plan of correction due date: Mar 7, 2025

REAPPRAISALS The pre-admission appraisal, as specified in Section 87457... shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. This requirement is not met, as there is no current appraisal or IPP for client #4, who was admitted 8/2022. Licensee failed to ensure that updated appraisals are maintained for cll clients, which poses a potential health, safety or personal rights risk to client in carethe state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Current IPP or reappraisal for client #4 to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(1) · Plan of correction due date: Mar 7, 2025

HEALTH AND SAFETY CODE (Initial) training shall consist of 40 hours... 20 hours, including 6 hours specific to dementia care...and 4 hours specific to postural supports, restricted health conditions, and hospice care... before working independently with residents. The remaining 20 hours shall include 6 hours specific to dementia care and shall be completed within the first 4 weeks of employment. This requirement is not met, as there is no evidence that 2 out 5 new staff received initial training, which poses a potential health, safety or personal rights risk to clients in care. No info on training for staff #2 and #7the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Proof of correction that staff #2 and #7 received required 40 hours of initial training to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.625(b)(2) · Plan of correction due date: Mar 7, 2025

HEALTH AND SAFETY CODE Training requirements shall...include an additional 20 hours annually, 8 hours of which shall be dementia care training, as required by subdivision (a) of HSC 1569.626, & 4 hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This requirement is not met, as there is no evidence that 2 staff received annual continuing training in 2024, which poses a potential health, safety or personal rights risk to clients in care. No annual training for staff #5 and #6.the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Proof of correction that staff #5 and #6 received required 20 hours of annual training to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69(b) · Plan of correction due date: Apr 4, 2025

HEALTH AND SAFETY CODE Each employee who ...continues to assist with the self-administration of medicines, shall also complete 8 hours of in-service training on medication-related issues in each succeeding 12-month period. This requirement is not met, as there is no evidence of medications training in 2024 for 2 staff. Licensee failed to ensure that staff who handle medications received annual continuing medications training, which poses a potential health, safety or personal rights risk to clients in care. No medication training in 2024 for Staff #5 and #6.the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Proof of correction that staff #5 and #6 received required 8 hours of annual medication training to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(f) · Plan of correction due date: Mar 7, 2025

PERSONNEL REQUIREMENTS All personnel...shall be in good health, & physically & mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than 6 months prior to or 7 days after employment or licensure. A report shall be... signed by the examining physician...whether the person is physically qualified to perform the duties to be assigned... has any health condition that would create a hazard... No health screening/ TB test results for S2, S3, S6, S7the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Current health screenings and/or TB test results for S2, S3, S6, S7 will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a)(1-8) · Plan of correction due date: Mar 7, 2025

PERSONNEL RECORDS The licensee shall ensure that personnel records are maintained on...each employee.... contain the following info: Employee's full name, Social Security #, date of employment, written verification that the employee is at least 18 years of age...home address and phone number, educational background, past experience, including types of employment and former employers, type of position for which employed. This requirment was not met, as job applications are not maintained for 2 out of 7 staff, which poses a potential health or safety risk. No job applications for S4 & S7.the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Copies of job applications for staff #4 and #7 to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(6) · Plan of correction due date: Feb 27, 2025

INCIDENTAL MEDICAL CARE A record of centrally stored Rx medications for each resident shall be maintained and include names of the resident for whom prescribed, prescribing physician and pharmacist, drug name, strength and quantity, dates filled, started & expiration, prescription number and instructions. This requirement was not met, as meds for client #3 and Senna 12/14/24 for client #2 are not recorded on Centrally Stored Medication Record, which poses a potential health, safety or personal rights risk.the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Clients' medications were recorded on Centrally Stored Medications Records in LPA's presence Deficiency corrected and cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87217(g)(1) · Plan of correction due date: Feb 28, 2025

SAFEGUARDS FOR RESIDENT CASH Each licensee shall maintain adequate safeguards and accurate records of cash resources & valuables entrusted to his care, including....records of residents' cash resources maintained as a drawing account shall include a ledger accounting (columns for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. This requirement is not met, as P & I records & cash for C2 and C5 are not accurate& staff were unable to describe cash handling procedure & recordkeeping.the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Recordkeeping of clients' P & I monies will be modified to reflect CURRENT and ACCURATE cash on hand. Transaction records will be maintained BY MONTH, with cash balances carried forward. Proof/plan of correction to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.695 · Plan of correction due date: Feb 28, 2025

HEALTH & SAFETY CODE A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required.... shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met, as there is no record of any disaster drills preformed, which poses an immediate health and safety risk to clients.the state’s words, verbatim · CDSS document, Feb 27, 2025

Plan of correction: Emergency disaster drills shall be conducted quarterly and documented. Plan/proof of correction to be sent to CCLD BY DUE DATE, and documentation of emergency drill to be sent to CCLD when conducted.

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds, consisting of 6 private client bedrooms--2 of which have exit doors to outside, and 3 of which have private full bathrooms. There is a common bathroom, living room, dining room, and kitchen. Backyard is level and fenced, and there is a detached storage shed. There are 3 staff present. A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature is tested. Food supply and first-aid kit are inspected. All client files are reviewed. Centrally Stored Medications Records and clients' cash handling records will be reviewed at a later date. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as other staff records. Isabelle Gil is a certified RCFE administrator (x 6/26) that oversees facility operations. Due to time constraints, this report is incomplete. Deficiencies observed will be cited at a later date. The following forms/information are requested to be completed and returned to CCL by 3/11/25: • LIC 309 Administrative Organization • LIC 400 Affidavit regarding Client Cash Resources • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • LIC 610D Emergency Disaster Plan (signed and dated) • LIC 9282 Infection Control Plan - Proof of control of property (signed and dated lease) - Proof of current liability insurance - Annual license renewal fee of $1237 is due and payable. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on page THREE.the state’s words, verbatim · CDSS document, Feb 25, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Feb 26, 2025

MAINTENANCE AND OPERATION Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F and not more than 120 degree F . This requirement is not met, as hot water temperature tested at 132 degrees in common bathroom, which poses an immediate health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Feb 25, 2025

Plan of correction: Hot water temperature to be lowered and maintained between 105 and 120 degrees. Proof of correction to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(1) · Plan of correction due date: Feb 26, 2025

PERSONAL RIGHTS Residents in all RCFEs shall have ...the right...to be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met, as there are video baby monitors in 3 clients' rooms, so staff can monitor clients from the kitchen. This poses an immediate personal rights risk to clients in care. Cameras are placed in rooms of clients #1, #3, #4, and provide video and audio surveillance.the state’s words, verbatim · CDSS document, Feb 25, 2025

Plan of correction: Video baby monitors will be removed and not used. Proof of correction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Feb 26, 2025

CRIMINAL RECORD CLEARANCE All individuals subject to a criminal record review pursuant to H & S Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility, request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is not met, as 5 staff out of 7 staff files reviewed DO NOT have criminal record clearance associated to this facility. This poses an immediate health, safety or personal rights risk to clients, and civil penalty is assessed at $100/each. Three staff have been employed for over 7 months.the state’s words, verbatim · CDSS document, Feb 25, 2025

Plan of correction: Criminal record clearances for Staff 1, 2, 3, 4, 7 must be associated/transferred to this facility. Proof of correction to be submitted to CCLD BY DUE DATE to avoid additional penalty assessments.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Feb 25, 2025

STORAGE SPACE The licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met, as Comet cleanser stored in bathroom cabinet in private bathroom of client #1, which posed an immediate health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Feb 25, 2025

Plan of correction: Comet cleanser was removed from client's bathroom in LPA's presence. Deficiency corrected and cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Feb 26, 2025

FIRE CLEARANCE All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services.... Prior to accepting or retaining ...bedridden persons, the licensee shall notify the licensing agency & obtain an appropriate fire clearance approved by the city, county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement is not met, as client #4 is bedridden, but there is no approved fire clearance for bedridden, which poses an immediate health and safety risk.the state’s words, verbatim · CDSS document, Feb 25, 2025

Plan of correction: Plan/proof of correction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(8) · Plan of correction due date: Mar 4, 2025

INCIDENTAL MEDICAL CARE A complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least... specific items. This requirement was not met, as first aid kit only contains Medihoney, several bandaids, a flex fabric, cold pack, and tweezers. Licensee failed to ensure that first aid kit is complete, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Feb 25, 2025

Plan of correction: First aid kit will be maintained and include required items. Proof of correction will be sent to CCLD BY DUE DATE.

Type of visit: Required - 1 Year

On 02/21/2024 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced 1 year annual inspection visit. LPA met with caregiver Elnora Panilag and explained the purpose of today's visit. LPA toured the facility inside and outside. Emergency exit routes are free and clear of obstructions. The facility's ambient temperature is comfortable and warm. Water is tested in two communal bathrooms as being 120F. Residents have an adequate amount of linens and incontinence supplies, incidental supplies, as well as PPE as needed. One fire extinguisher is observed in the kitchen. Upon observation of the charge on the dial display it is within the green zone indicating it is charged and ready for use. The inspection tag indicates it was last inspected on 09/25/2022. Facility is equipped with fire sprinklers. Carbon monoxide detectors and smoke detectors are present through out the facility. Two resident bathrooms were observed to be in good repair. Client bathrooms are observed to be in working order with clean shower curtains and non-skid surfacing and strips are in place. 7 day non-perishable food supply and 2 day fresh food supply is observed as in place. Kitchen is observed as operable and clean. Appliances are in good working order. LPA observed that the knives for cooking is locked in a small cabinet next to the stove. Medications are also observed as locked in a stand up cabinet in the kitchen. Medications are inaccessible to residents. Medication administration record is observed as current. First aid kit is observed with the medications as complete. 2 resident files are reviewed as being current. Continue on next page... Page 2 - LIC809C On site laundry is available and functioning per observations made in the garage. Cleaning supplies are observed as locked in garage and in storage cabinets in the garage. An additional refrigerator is located in the garage that contains additional resident food as well as staff's personal food items. 2 client records are checked and both are complete and updated. At time of inspection, there is only one resident who has money being stored for safekeeping by staff. This is inspected and is observed as current. 3 Staff files are reviewed as current. At time of inspection. There is one staff (S1) not associated to the facility and no fingerprint clearance on record with the Department. The following updated items are requested to be sent to the Department by 02/28/2024: • LIC610D Emergency Disaster Plan • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • Updated administrator certificate • LIC9020 Client Roster • Certificate of Liability Insurance • Proof of control of property • Surety bond with expiration date Citations issued on following LIC809D. Civil penalty assessed for staff person with no finger print clearance on file with the Department and not being associated to the facility. S1 x (2 violations) at $100 = $200 Report is reviewed with caregiver Elnora Panilag.the state’s words, verbatim · CDSS document, Feb 21, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Feb 22, 2024

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by: Based on records review, licensee failed to request a transfer of criminal record clearance for S1 and S2 which poses an immediate health and safety risk to clients in care. It is confirmed that S1 and S2 are not associated to the facility on this day 7/1/2022.the state’s words, verbatim · CDSS document, Feb 21, 2024

Plan of correction: Administrator shall ensure to submit a criminal record clearance transfer request to the licensing office for S1 by the POC due date. Also submit proof of correction and a written plan outlining how this violation will be avoided in the future to licensing office by due date. Immediate civil penalty of $100 for S1 and is being assessed on this day.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(1) · Plan of correction due date: Feb 22, 2024

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by: Based on records review, licensee failed to obtain a criminal record clearance for S1 which poses an immediate health and safety risk to clients in care. It is confirmed that S1 does not have a criminal record clearance on this day.the state’s words, verbatim · CDSS document, Feb 21, 2024

Plan of correction: Administrator shall ensure to submit a criminal record clearance transfer request to the licensing office for S1 by the POC due date. Also submit proof of correction and a written plan outlining how this violation will be avoided in the future to licensing office by due date. Immediate civil penalty of $100 for S1 and is being assessed on this day.