101170(e)(2) · 101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f).

Licensee shall submit a transfer request for staff (S-3) by POC due date 4/21/2024 to the department. Staff (S-3) has been assoicated to facility deficiency cleared during visit. Based on record review, the licensee did not comply with the section cited above staff (S-3) is not associated to the facility in which poses/posed a potential health, safety or personal rights risk to persons in care. Susy Cervantes NAME OF LICENSING PROGRAM MANAGER: Elizabeth Larios NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/14/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Open Not marked corrected in the state record

Category: background checks. Open / not marked corrected.