Sta. Rita's Senior Care

Allegation investigated: Staff is sexually abusing a resident

On 3/19/26 Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to complete and close the investigation into an allegation noted above. Upon arrival,LPA met with care staff Joel Cruz (S2) and Esmalla Ehmije (S3) and explained the purpose of the visit. Administrator, Rita Flower was not present during this visit. Allegation: Staff is sexually abusing a resident It was alleged “Staff is sexually abusing a resident” this investigation consisted of interviews with staff, residents, and records review. Upon record review and interviews, it was also discovered that there is no history of a resident in care for this facility whom matches the name, ethnicity, and primary language of the alleged victim. On 2/10/2026, LPA Tamayo attempted to interview Reporting Party (RP) but was unable to do so. RP did not follow up with the Department. CONTINUED ON 9099-C Unsubstantiated On 2/11/26 and 3/9/2026 the Department interviewed residents in care, of which two out of two residents interviewed reported no concerns related to the facility staff and did not witness any staff act inappropriately with any clients; The Department attempted to interview two additional residents but did not receive responses to interview questions and one resident was not present at the facility due to hospitalization. Three out of three staff interviewed on 2/11/26 and 3/9/2026, stated staff do not mistreat any residents and there has not been any staff has sexually abused a resident. Administrator, Rita Flowers (S1) stated that Resident 5 (R5) is a new resident and staff started to notice they were having "hallucination" like that of psychosis. S1 stated this change in condition resulted in them noticing that R5 starting to make false claims and say“unusual things” including saying stated staff were hurting Resident 4 (R4). S1 thinks this is because R4 suffers from a lot of pain and is often heard complaning of pain, they say “oww” or “ahh” out loud and R5 likely thought that “R4 was being hurt by staff for some reason”. Staff 3 (S3) and Staff 2 (S2) stated that R4 was making “odd comments” such as saying “they saw us bury a pig in the backyard” which is untrue. S2 stated R4, R5, nor other residents are abused by staff, “I don’t know why [they] say that”. S1 stated that on 2/9/26, R5 called 911 and they told the Paramedics that a resident was being abused. R5 was transported to the hospital per their request. The sheriffs came to the facility later that day to speak with R4 but they were unable to do so because R4 did not respond to any questions. R5 has not returned to the facility and no longer resides at this facility. On 2/11/26 and 3/9/2026, the Department also attempted to interview R4 but they did not respond to interview questions. Based on review of records and interviews, the allegation “Staff is sexually abusing a resident” is unsubstantiated, as there is not a preponderance of the evidence to prove that the alleged violation. Although the Department has determined that the allegation above is unsubstantiated, if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility S2 and a copy of this report was left at the facilitythe state’s words, verbatim · CDSS document, Mar 19, 2026 · control 27-AS-20260210090139

Type of visit: Required - 1 Year

On 2/11/26, Licensing Program Analyst, LPA, Cynthia Tamayo arrived toarrived unannounced to conduct an annual inspection. Upon arrival,LPA met with care staff Joel Cruz (S2) and Esmalla Ehmije (S3) and explained the purpose of the visit. Administrator, Rita Flower was not present, S2 called S1 and they arrived moments later. An entrance interview was conducted. Sta. Rita's Senior Care is a Residential care elderly licensed to serve five (5) non-ambulatory residents age ranges 60 years old and above. Five (5) non-ambulatory may only occupy bedroom #1-5. Hospice waiver approved for three (3) residents. There are 5 residents in care. LPA observed here were 2 staff present and four residents were having rice and meat for lunch. Resident 5 (R5) was not present at the facility due to being hospitalized. S1 stated they submitted an incident report (SIR) to the Regional office today. LPA reviewed reporting requirements and the need to be as detailed as possible for reports. S1 will submit an amended/additional SIR and will create a re-appriasal for R5. LPA toured the facility with S3 and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 73 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 115.1 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. LPA Tamayo observed first aid supplies, there was a fully-charged and up-to-date fire extinguisher, and functioning carbon monoxide/smoke detectors that are tested periodically. Continued on 809-C The facility is conducting quarterly emergency drills and ensuing to use alternating exits during simulations. LPA Tamayo observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA observed a locked cabinet for the storage of medication. LPA Tamayo observed locked cabinets for the storage of cleaning solutions and knives. The exterior of the building was inspected: There were no outbuildings or bodies of water present and the yard was completely fenced in. There was also a sitting area for residents in the backyard. Staff and resident files were made available for inspection during this visit. LPA reviewed three resident files (R1-R3) and three staff files (S1-S3). Administrator certificate # 7005966740 and it expires 8/30/2026. SOC341A will be completed for all staff and added to staff files. LPA compared the LIC 500 with the roster of staff obtained from Guardian to ensure that all staff had the appropriate background clearances to be working with the residents in care. All were in compliance at the time of this inspection. LPA interviewed two staff members and four residents. S1 reported that activities include singing, exercise, and games. LPA requested the following documents by 2/20/26 by 5:00PM: LIC 500: Personnel Report LIC 308: Designation of Administrative Responsibility LIC 309: (for any LLC or Corp) if applicable LIC 402: Surety Bond, if applicable LIC 610E: Emergency Disaster Plan Copy of current Liability Insurance Licensee will ensure to pay annual licensing fees by due date. LPA provided guidance via LIC 9102. According to the California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. A copy of this report was provided and an exit interview conducted.the state’s words, verbatim · CDSS document, Feb 11, 2026

The state marks this report as 13 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff did not take preventative measures to ensure resident does not sustain pressure injuries. Resident sustained unexplained injuries while in care. Staff did not meet resident's diapering needs. Staff did not properly transfer resident's items to new facility. Staff did not notify resident's responsible party of incidents.

Licensing Program Analysts (LPA) Cynthia Tamayo made an unannounced inspection to the Sta. Rita Senior Care RCFE on 11/06/25.The purpose of this visit is to o conclude the investigation of the above allegations and to deliver the findings for the allegations above. LPA Tamayo met with care staff Joel Cruz (S2), and explained the purpose of the visit. S2 called facility administrator, Rita flowers (S1) via phone call, S1 stated they are out of the country and will return 11/10/25 but are available via phone call. The most current LIC 308 lists two staff whom are no longer working at the facility, S1 stated the visit may be conducted with S2. The investigation into the above allegations consisted of interviews and record reviews. The Department conducted interviews and records review for the above complaint allegations. CONTINUED ON 9099-D Substantiated It was alleged that staff did not take preventative measures to ensure resident does not sustain pressure injuries. LPA conducted staff interviews and review of records the allegation; Interview with a witness (W1), hospice resident (R1) was found to have multiple wounds and sores injuries. W1 stated that a hospice staff informed facility staff of some injuries were the result of R1’s being double diapered by facility staff. Interview with another witness (W2 ), confirmed that staff did take preventative measures to ensure resident does no however this was not the case in 2-3 occasions in which facility staff was double diapering R1 which could have resulted in pressure injuries and delayed healing. Record review of hospice records indicate a pressure ulcer was documented on 8/21/25 on right hip, 8/19/25 on left foot, 8/26/25 on lower right back, and on left thigh on 9/4/25 . Skin tears are noted. on 8/28/25 on right wrist and right knuckle and a blister on the tight waist. Hospice notes stated education was provided to facility staff on how to care for and off-load pressure areas. Interview with Administrator, S1 confirms hospice staff held a meeting with the facility to address double diapering of staff in which staff was instructed to no longer do so. S1 stated the staff member that was double diapering the resident is no longer working at the facility since April 2025. S1 and S2 confirm R1 did not have any pressure wounds prior to their admission to the facility, although the R1 had "sensitive skin". W2 stated that although total wound healing was not expected, one facility staff could have done more to prevent pressure injuries. S1 instructed care staff to start maintain progress notes for R1 per Long Term Care Ombudsman's recommendation. LPA reviewed progress notes for R1 from 8/26-9/5/25. Based on the observations of the LPA and review of records the allegation staff did not take preventative measures to ensure resident does not sustain pressure injuries is substantiated. It was alleged that resident sustained unexplained injuries while in care. LPA conducted staff interviews and review of records the allegation; LPA observed photographs of wounds sustained by R1 in the pinky knuckle of their hand, the side of their toe on their foot, and on their knee. W1 stated when facility staff asked what happened to R1 or how a certain skin tear occurred, Staff would respond "I don’t know". S2 stated they conducted body checks but there was no log, S2 would sometimes report observed wounds to family but not always due to hospice reporting to family already. CONTINUED ON 9099-D S1 and W2 stated R1 had very " fragile skin". W2 stated this meant it needed more care. W2 stated they advised that patients should not be sitting all day, as they lay down after meals to off-load pressure, but this was sometimes not done per family's request to not have R1 to be isolated in their room during the day. Hospice staff provided training on how to prevent pressure injuries but staff did not always follow thru completely with training guidelines including turning R1. Hospice staff was not full time, so facility care staff was responsible for the full time care. Based on the observations of the LPA and review of records the allegation resident sustained unexplained injuries while in care is substantiated. It was alleged that staff did not meet resident's diapering needs. LPA conducted staff interviews and review of records the allegation. W1 and W2 stated two diapers were observed on R1 on more than one occasion. The facility staff requested XL diapers even though R1 was not size XL. S1 and S2 stated they met with the hospice team to address double diapering not being allowed, as it was resulting in pressure injuries. A witness (W3) stated they saw blisters on thighs and inside of waist of R1. Per plan of operation and admissions agreements the facility agrees to provide “… routine observation, care and supervision, and personal assistance and care with their needs and activities of daily living. These needs are indicated by the results of the preadmission appraisal, family and resident interviews, physician consult, etc. Personal assistance and care includes dressing, grooming, eating, bathing and assistance with taking prescribed medications’”. Based on the interviews and review of records the allegation, staff did not meet resident's diapering needs, is substantiated. It was alleged that staff did not properly transfer resident's items to new facility.LPA conducted staff interviews and review of records the allegation. Based on interview with S2, they stated they put everything is in the boxes with everting they think R1 needed, in the "care-kit". S1 stated they told R1's family to check the room, in which they did but did not take anything additional. R1's daughter returned back to the facility due to diapers, toiletries, personal blanket, razors, dentures, and belongings that were not packed the first time. S2 stated they did not pack those items because they thought they didnt need them or where donations. R1's son requested R1's POLST, and S2 stated they did not have one. S1 stated R1 does have a POLST but S2 did not understand what a POLST was. CONTINUED ON 9099-C Per plan of operation: basic services provided include “assistance with bathing, dressing, grooming, toileting, eating, continence, transferring from bed or chair, and other personal needs”. LPA conduced records review and interviews. S1 stated the facility did not maintain a grooming log including shaving, nail maintenance, and showering schedules. S2 stated hospice staff and they were both in charge of grooming for R1. S2 and W2 stated R1's family member requested for staff the shave R1s beard by putting staff's fingers in R1's mouth to assist with shaving due to R1 not having any teeth, however care staff states this was not safe to do. Interview with two witnesses (W1 and W2) as well as one Staff (S1) confirm R1 did not have any teeth which made it "challenging" or "unsafe" to fully shave R1 often. S2 stated an electric razor was provided to the facility as it was requested, however. S2 reports R1 was not always "cooperative" and grooming attempts were attempted later on when R1 would be more "not combative"". Although R1 did not have teeth, "He tries to bite us" and "we will try again once the beard is a longer so its more do-able "Per department regulations it's a residents' personal right to refuse services at any time. Department has determined no violations were observed regarding grooming. Based on the observations of the LPA and review of records the allegation Staff did not ensure resident's grooming needs were being met is unsubstantiated. It was alleged staff mismanage resident's medications. LPA Tamayo Reviewed medications and medications records for R1- R5. R2- R5 did not have any discrepancy showing any evidence of mismanagement of resident's medications. S1, and S2 stated all medications were administered to R1-R5. W2 stated they did not witness any discrepancy with medications or any medication mismanagement by the facility staff. W1 and W3 stated there was one medication that was not administered to R1 on a daily basis to to low refills. R1 and or R1's family took all their medications and some medication records with them upon move out on 6/9/25. LPA Tamayo reviewed record keeping requirements with facility staff. LPA was not able to corroborate the allegation staff mismanage resident's medications. Although the allegations above may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of personal rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff and a copy of this report was left at the facility. S1 confirmed a copy of the POLST was available to the R1's authorized representative at move out. Based on the observations of the LPA and review of records the allegation, staff did not properly transfer resident's items to new facility, is substantiated. It was alleged that Staff did not notify resident's responsible party of incidents. LPA conducted staff interviews and review of records the allegation. Interview with S1 confirms staff tired notify resident's responsible party of incidents, but did not always do so. S1 had staff start to maintain 'progress notes" to serve as reporting as of 8/26/25 but there was no other reporting verification available to families before 8/26/25. S1 stated there is sometimes a language barrier between S2 and families and S2's word choice "could be better". S1 and S2 stated S2 could have been more consistent with ensuring better with S1 and responsible parties. S2 was instructed to notify S1 of any type of injuries or incidents that involved residents so S2 can communicate with families but S2 did not always do so. Based on the observations of the LPA and review of records the allegation, staff did not notify resident's responsible party of incidents is, substantiated. As a result, the allegations above are SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with care staff Peti and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility.the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 27-AS-20250915085945

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Nov 14, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical .... routine medical ... care ...(1) ...l arrange, or assist in arranging, for medical ... care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by record review and interviews that corroborate staff did not implement preventative measures or follow care instructions provided by Hospice staff, which resulted in the resident developing pressure injuries while in care. This poses a potential or immediate health risk to residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will submit a plan to maintain turning schedule, and skin check monitoring, for all residents at risk for developing pressure injuries by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Nov 14, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by record review and interviews confirming resident 1 (R1) developed bruises and skin tears however Facility staff was unable to provide an explanation or documentation of all incidents; It was the hospice company who was mostly communicating incidents to responsible persons. Additionally, staff did not ensure all of R1's personal belongings were transferred to the facility upon relocation on 9/5/25. This poses a potential or immediate health risk to residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will implement a plan to ensure the facility is consistently communicating with hospice and responsible representatives by POC due date. Additionally, licensee will submit a plan for move out procedures for residents to ensure all belongings are relocated along with resident.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87464(c) · Plan of correction due date: Nov 7, 2025

87464 Basic Services (c)... basic services are desired and/or needed ... provided for, each resident...This requirement was not met as evidenced by records review and interviews. Based on records review and interviews, staff used two diapers on R1 instead of doing more frequent changing. "Double diapering" is a practice that can cause pressure injuries. Staff was told to discontinued double diapering but still continued to do so on more than one occasion. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will submit a plan to ensure diapering needs of resiednts are met by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Nov 14, 2025

87211 Reporting Requirements (a) Each licensee ... (1) A written report shall be submitted to the licensing agency and to the person responsible....(D) Any incident which threatens the welfare, safety or health of any resident ... This requirement was not met as evidenced by staff not reporting when R1 had a wound to authorized representatives, this poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will submit a plan to ensure staff did not notify resident's responsible party of incidents by POC due date.

Type of visit: Case Management - Deficiencies

On 11/6/2025, Licensing Program Analyst (LPA) Cynthia Tamayo visited the facility unannounced to conduct a case management visit- deficiencies. LPA Tamayo met with care staff Joel Cruz (S2), and explained the purpose of the visit. S2 called facility administrator, Rita flowers (S1) via phone call, S1 stated they are in the Philippines and will return 11/10/25. The most current LIC 308 lists two staff whom are no longer working at the facility, S1 stated the visit may be conducted with S2. The current census for today was four. There were currently two staff present. The facility is licensed to serve five (5) non-ambulatory residents age ranges 60 years old and above. Five (5) non-ambulatory may only occupy bedroom #1-5. Hospice waiver approved for three (3) residents. The purpose of this visit is to follow up on deficiency observed on 9/18/25, in which staff were signing off medication on the Medication Administration Records (MARs) in advance of actual administration for all residents. LPA observed the all medications listed on the MARS sheet for R1 was signed off from 9/1/2025 - 9/18/2025, even though R1 moved out on 9/5/2025. S2 admitted to signing off medication records in advance, which constitutes a deficiency per California Code of Regulations, TITLE 22. LPA was reviewing resident records in which it was found that LIC 602 Physicians report for R4, indicated they are bedridden. S1 and S2 stated R4 can turn on their own and a request for an updated LIC 602 will be requested on this day. CONTINUED ON 809-C LPA observed R4 was laying down in their bed and they were able to reposition on their own but needed assistance to transferring onto a wheel chair. LPA reviewed bedridden and fire clearance regulations with S1 and S2, S1 stated an updated LIC 602 will be requested today. Additional Technical Violations were provided along with resources from Technical Assistance Program (TSP) including "Hospice" and "Pressure Wounds" guides. As a result of this case management visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with S2 and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Nov 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(d)(3) · Plan of correction due date: Nov 7, 2025

87465 Incidental Medical and Dental Care (d)... for a prescription or nonprescription PRN medication. .. facility staff designated by the licensee, shall ... assist the resident with self-administration ...(3) The date and time ... medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the This requirement was not met as evidenced by records review and interviews: review of medication administration record (MAR) dated September 2025 revealed that staff signed for medications as given prior to the actual administration. Additionally, S2 did not complete the MAR on 11/6/25 immediately after administering the medications to residents in care. Interview with staff confirmed that they pre-sign MARs to "save time". The practice constitute inaccurate medication documentation and fails to ensure that medication records reflect the actual time and date of administration, as required by Title 22. This poses an immediate health and safety risk to residents in care, as medications may be missed, duplicated, or administered incorrectlythe state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will submit a plan to ensure all staff responsible for medication assistance will receive a retaining on medication administration and accurately maintaining medication administration records (MARs) by POC due date

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Nov 14, 2025

87405 Administrator - Qualifications and Duties (a) .... When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility... This requirement was not met as evidenced by LIC 308 listing two individuals whom are no longer staff at the facility. S1 and S2 stated administrator was out of the country during this visit but available to staff via phone call for any staff or resdeint needs.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will submit an updated LIC 308 by POC due date.

Type of visit: Required - 1 Year

On 4/23/25, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct a Required - 1 Year visit. LPA initially met with Staff member, Jovita Ugalino and was later joined by Administrator, Rita Flowers, and explained the purpose of the visit. Administrator holds current certification expires on 8/30/2026. The facility is licensed to serve up to five (5) non-ambulatory residents. Hospice approved for three (3) residents. There are currently five 5 residents in care one of which is in Hospice. LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, garage, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 115.8 degrees Fahrenheit which was within the required range of 105-120*F. The temperature inside the facility measured at 71 degrees Fahrenheit which was within the required range of 68-85*F. Report continued on 809-C LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. Proof of current liability insurance was observed. LPA requested resident and staff files for review. LPA reviewed (4) staff files and (5) resident files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. The following forms and documents were requested to be submitted within 15 days: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed. Exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 23, 2025

Type of visit: Required - 1 Year

On 3/28/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a Required - 1 Year visit. LPA met with Administrator Rita Flowers and explained the purpose of the visit. Administrator holds current certification #6019965740 and expires on 8/30/2024. The facility is licensed to serve up to five (5) non-ambulatory residents. Hospice approved for three (3) residents. There are currently five (5) residents in care. LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, garage, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 119.5*F which was within the required range of 105-120*F. The temperature inside the facility measured at 74*F which was within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. Proof of current liability insurance was observed. Report continued on 809-C LPA requested resident and staff files for review. LPA reviewed (2) staff files and (5) resident files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. The following forms and documents were requested to be submitted within 15 days: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed. Exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 28, 2024