Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced case management visit during the complaint visit 28-AS-20240205143121. LPA met with Staff#1 (S1), staff at the facility and spoke with Staff#2 (S2) house manager Shirley Esguerra, over the phone. The purpose of the visit was to check on the Health and Safety of the residents and facility. The purpose was discussed with house manager. On today’s visit, LPA conducted a health and safety check. LPA toured the physical plant of the facility and staff file reviews. LPA obtained a copy of the staff/ client roster.

LPA reviewed clients' records from client#1 to client#5, and observed clients' files were incomplete which were missing one or multiple forms/documents listed below:

· I.D. and emergency information (facesheet)

· Centrally stored Medication Destruction records

· Safeguards for Cash resources (P&L if handling client’s money at the facility)

· Personal rights (LIC 613, LIC 613B or LIC 613C)

· Cash resources information (if handling client’s money at the facility)

Deficiencies of Health and Safety were observed per Title 22 Regulations Division 6 Chapter 8. Exit interview was conducted with staff#1 and a copy of this report, LIC 809D, and appeal rights were provided.