Community Care Licensing

NARRATIVE

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility for a complaint. During the complaint visit, LPA Rico completed a case management visit to cite for two (2) deficiencies and one (1) civil penalty found during facility tour and record review. During facility tour, LPA observed R1 and R2 sliding door for their closet not working. During staff interview and record review. S1 confirmed to LPA they have been working since August 2023. During record review LPA confirmed S1 has a criminal record clearance but is not associated to the facility. LPA Rico informed Administrator that S1 must be associated to the facility. During today’s visit, two (2) deficiency and one (1) Civil penalty was assessed with the amount of $500.00 for failure to associate/transfer S1 Criminal Record Clearance to the facility were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report, LIC809, LIC809D, LIC421BG and Appeal Rights were discussed and provided to Care Giver Eula Jones.

SUPERVISOR'S NAME: Efren Malagon TELEPHONE: (951) 248-0337 LICENSING EVALUATOR NAME: Mary Rico TELEPHONE: (951) 248-0293 LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023

Document Has Been Signed on 11/16/2023 04:20 PM - It Cannot Be Edited

FACILITY NAME: LOVE 2 CARE HOMES	FACILITY NUMBER: 361880919
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/30/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will provided proof that sliding door has been repaired.
	8 9 10 11 12 13 14	Based on observation and interview the licensee did not comply with the section cited above by R1 and R2 sliding door not in good repair which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	POC due date 11/30/2023
Type B 11/20/2023 Section Cited CCR87355(e)(2)	1 2 3 4 5 6 7	87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... (2) Request a transfer of a criminal record clearance... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will transfer S1 criminal record clearance to facility and provided proof to LPA
	8 9 10 11 12 13 14	Based on observation, interview and records review, the Licensee did not comply with the section cited above by not transferring the criminal background clearance of Staff #1 to the facility who had been working at the facility which pose potential health, safety and personal rights risks to residents in care.	8 9 10 11 12 13 14	POC due date 11/20/2023

SUPERVISOR'S NAME: Efren Malagon TELEPHONE: (951) 248-0337 LICENSING EVALUATOR NAME: Mary Rico TELEPHONE: (951) 248-0293 LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023