Facility Evaluation Report

On 09/19/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Case Management visit at this facility. LPA was greeted by Executive Director Amado Achiva and explained the purpose of the visit to conduct a health and safety check. LPA explained the inspection visit is in association with an incident on 09/10/24.

On 09/10/24, Cathy Nguyen , Site Manager reported an incident concerning client #1 (C1) and staff #1 (S1) involving (C1) who gained access to a toxic chemical. Information reported indicated (S1) was cleaning and spraying down the gym area with Lysol Disinfectant when (C1) got a hold of the toxic chemical and sprayed in (C1’s) mouth.

The Department interviewed Executive Director (ED#1) regarding the incident involving (C1) and (S1). (ED#1) stated the (S1) had left out the toxic chemical that (C1) gained access to the hazardous chemical.

During today's inspection visit, LPA Dabuet audited service records for clients #1 (C1) and staff #1 (S1). As a result of a review of (C1’s) Preplacement Appraisal LIC 603 (dated: 03/21/24) and Individual Person Center Plan (dated: 10/27/23) it revealed (C1) requires adult supervision while out in the community and requires special observation due to short attention span/wandering behavior.

Based on observations, interviews, and record reviews, a preponderance of evidence standard has been met. (S1) failed to carry out the responsibilities and duties of a Direct Support Provider who failed to store toxic chemicals and allowed access for clients in care. California Code of Regulations, Title 22, Division 6, and Chapter 3 are being cited on the attached LIC 809-D.

An exit interview was conducted with Cathy Nguyen and a hard copy of the report along with appeal rights.