Facility Evaluation Report

On 12/8/2022 at 10:35 AM Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct a case management visit regarding incident report received on 11/22/2022, about C1 sustained bruise. LPA met with Caregivers S3, staff S2 and S4. The staff called the Administrator Nicholas Marcelo. LPA spoke with Nicholas M, LPA informed Administrator the purpose of the visit. At around 11:35AM, Administrator arrived at the facility.

LPA toured the facility’s inside and outside. During the tour and staff interview, LPA observed the following;

1. Medication cabinet observed to be unlocked which was accessible to clients in care.

2. Cleaning product and pair of scissors was observed to be unlocked and accessible to clients in care

3. Staff did not conduct covid19 screening to LPA upon entering the facility. Technical assistance provided.

During the case management visit, LPA gathered documents such as but not limited to; LIC500, staffing schedule, copy of C1’s physician’s report, C1’s individual program plan (IPP), C1’s individual service plan (ISP). LPA conducted staff and client’s interview. LPA requested for facility staffs’ names with their contact numbers to be sent by 12/9/2022.

Due to insufficient information at this time, LPA will conduct additional interviews and documents reviews. LPA will return to the facility.

Deficiency is cited from Title 22 California Code of Regulations and listed 809D . Failure to submit proof of correction by plan of correction due date may result in civil penalty.

Exit interview conducted. A copy of this report and appeal rights provided.