Facility Evaluation Report

On 10/21/2022 at 1:27p.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Case Management visit for an incident report and SOC341 received by CCLD on 10/10/2022. Carmen Galicia, Administrator faxed the Special Incident Report and SOC341 to the CCLD office as indicated on reporting requirements. Upon arrival LPA met S1 and explain the reason for the visit. At 1:37 Administrator Carmen Galicia arrived, and LPA explained the reason for the visit.

During the visit LPA toured the facility. LPA interviewed administrator, and Residents R1 through R3. LPA obtained a copy of staff roster, Resident roster, Incident report dated 10/10/22, SOC341 dated 10/11/2022, R1’s psychiatric evaluation dated 10/14/2022, R2’s psychiatric evaluation dated 10/14/2022, house rules, and S2 internal incident report.