Facility Evaluation Report

On 4/17/2025 at 9:40am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 4/15/2025. LPA met with Christian Smith, Direct Care Support. Justine Esomonu, Administrator that arrived at 10:15am and explained the purpose of the visit.

The incident occurred on 4/14/2025, where C1 AWOL'd. C1 was admitted to facility on 10/7/2024. S1 stated on the day of the incident C1 was upset when he left. C1 came back damaged the door, neighbor's vehicle, then left again. S1 made a police report and contacted hospitals. S1 stated no one has heard from C1 and he has not returned. Physician's report dated 10/28/2024 indicated C1 is able to leave the facility unassisted. LPA requested a copy of C1's emergency contact, physician's report, appraisal needs and service plan, Individual Program Plan (IPP), and addendum to IPP to be emailed to LPA by end of day 4/17/2025.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

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