101216(l)(1)(B) · Personnel Requirements (B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. THIS REQUIREMENT IS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS WHICH REVEALED ONE STAFF MEMBER DOES NOT HAVE THE LIC 9052 EMPLOYEE RIGHTS FROM AND LIC 9108 STATEMENT REQUIRED TO REPORT CHILD ABUSE POC Due Date: 04/26/2023

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

101217(a)(13) · Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) A signed statement regarding their criminal record history as required by Section 101170(d).

Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. THIS REQUIREMENT IS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS WHICH REVEALED ONE STAFF MEMBER DOES NOT HAVE THE REQUIRED CRIMINAL RECORD STATEMENT (LICE 508) IN FILE POC Due Date: 04/26/2023