Facility Evaluation Report

On 01/31/23, Licensing Program Analyst (LPA) Yang arrived at the facility unannounced to conduct a case management inspection follow up visit from 10/21/22 on written incident report received.

LPA were greeted by caregiver Robert Gobea. LPA introduce self, stated the purpose of the visit and were granted entry into the facility. LPA requested to meet with Administrator. Administrator Jessica Delgadillo was called and arrived shortly.

On 10/19/2022, the department received self-reported written incident regarding Staff 1(S1) punched Client 1 (C1) in the face resulting in a black eye.

During the course of the investigation, the Department conducted interviews and reviewed records and based on interviews conducted, S1 hit C1 leaving C1 with a black eye.

Per California Code of Regulations, Title 22, Division 6, Chapter 1, a deficiency is being cited on the attached 9099-D. As a result of the incident, S1 hit C1 leaving C1 with a black eye, a violation that warrants a civil penalty assessment. A Civila Penalty is being assessed.

Exit interview was conducted. A copy of this report and appeal rights were given to Administrator, whose signature confirms receipt of this report.