Facility Evaluation Report

On July 2, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced case management visit at the day program. Upon arrival, the LPA performed a risk assessment and spoke with Program Director Patricia Ball. The purpose of the visit was to address an incident that occurred on June 26, 2025, involving Staff #1 and Client #1.

On June 26, 2025, Program Director Patricia Ball reported an incident concerning Client #1 (C1) and Staff #1 (S1), which involved a physical assault. The Department interviewed Patricia Ball (PD) and Client #1 (C1) regarding the incident. An interview with Staff #1 (S1) could not be conducted because the staff member was not present at the facility. The entire facility was inspected for health and safety compliance, and service records for Client #1 (C1) were provided, along with personnel records for Staff #1 (S1). According to (PD), Harbor Regional Center Quality Assurance Department conducted an investigation on June 30, 2025.

The following were records obtained from the facility:

Staff #1 - Application for Employment (dated 12/3/16)

Health Screening Report LIC 503 (dated 12/26/23)

Abuse of Dependent Adults and Elders (dated 12/09/24)

Copy of California ID and Social Security

Client #1 - Identification and Emergency Information LIC 601 (date 05/23/25)

Harbor Regional Center Face Sheet (dated 02/05/20)

Independent Horizons Inc Annual Review (dated: 06/06/25)

Physician's Report LIC 602 (dated 02/25/25)

Functional Capability Assessment LIC 9172 (dated 05/23/25)

Staff #2, #3, #4 and #5 written statements

An exit interview conducted with Program Director Pat Ball and a copy of the report was provided.

This report serves as an amendment to clarify line #3 & 4. It does not supersedes the investigation reflected on report created on 07/02/25.