Facility Evaluation Report

Licensing Program Analysts (LPA) Lavinia Muscan conducted unannounced case management visit on 10/31/2022. This visit is to confirm ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL FACILITIES.

LPA met with Administrator and stated the purpose of visit. Facility understands this is an Immediate Exclusion effective 10/31/2022 and S1 is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility.

Exit interview conducted, a copy of this report provided on this date. A signature on these forms acknowledges receipt of these forms.