Facility Evaluation Report

On 01/10/2023 at 12:00PM Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident reports received for Client 1 (C1). LPA met with Emily Carbonell, Staff and explained the purpose of the visit. Caregiver, Melva Reyes, arrived at 12:30PM. Administrator, Elvie Chu, arrived at 12:40PM

Upon arrival LPAs was greeted by Staff 2 (S2) whom was not associated to the facility.

Incident report sent on 12/31/2022 was for an AWOL for C1. Staff 1 (S1) stated that C1 left without notifiying any staff and stayed the night at a friend's house. C1 does not have a cell phone. S1 stated staff called friend and found that's where she was at the time. C1 returned the next day 1/1/2023.

LPAs collected the following documents during visit: C1's Individual Program Plan (IPP) addendum, and appraisal needs and services plan.

LPA requested the following documents be submitted by 1/13/2023: LIC500 Personnel Record and facility roster.