Background checksType A
- Official classification
- Type A
- Official code
- 87355(e)(2)
- Regulation authority
- CCR
What the official deficiency says
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, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or.. This requirement was not met as evidenced by: During the tour, LPA observed Staff 1 (S1) present in the facility. S1 was reported to reside in the facility. LPA conducted a record review which revealed S1 does not have a criminal record clearance or approved exemption to work, volunteer, or reside in the facility. This poses an immediate health/safety risk to residents in care.
Official plan of correction
Administrator Su escorted S1 out of the facility and reported S1 will not be allowed to return to the premises, indefinitely. POC met.
Deadline recorded: Apr 8, 2026. A deadline is not proof that correction was completed.
Background checksType B
- Official classification
- Type B
- Official code
- 87355(e)(3)
- Regulation authority
- CCR
What the official deficiency says
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, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or.. This requirement was not met as evidenced by: During the vist, Staff 2 (S2) was the caregiver present providing care and supervision to the residents. However, a record review revealed S2 is not associated with the facility. This poses a potential health or safety risk to residents in care.
Official plan of correction
Administrator reported they will contact the Department's Guardian Background Check System and request access to be able to associate staff with the facility. Administrator reported they will email LPA a Criminal Background Clearance Transfer Request (LIC 9182) form for S2 by close of business on 04/15/2026 if they are unable to gain access to Guardian and associate S2 through Guardian. POC to be emailed to LPA by close of business on 04/15/26.
Deadline recorded: Apr 15, 2026. A deadline is not proof that correction was completed.
Incident reportingType B
- Official classification
- Type B
- Official code
- 87211(a)(1)(D)
- Regulation authority
- CCR
What the official deficiency says
(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by: Administrator Su reported the facility did not verbally report or submit a written incident report to Community Care Licensing to report R1's elopement and hospitalization on 03/31/2026. This poses a potential health, safety or personal rights risk to residents in care.
Official plan of correction
Administrator Su agreed to contact an outside vendor to receive training for himself and all staff regarding the Department's reporting requirements pursuant to CCR 87211. Proof of training to be submitted to LPA by close of business on 04/30/2026.
Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.