Facility Evaluation Report

On November 21, 2024 at 8:57am Licensing Program Analyst (LPA) Zina Brown conducted an unannounced health and safety check to follow up on a incident that occurred on November 17, 2024. During today visit we met with Kristen Angeles (Facility Coordinator) and explained the purpose of the visit.

During today's visit, LPA conducted interviews with staff and clients. LPA also reviewed and collected the following:

LIC 601: Identification and Emergency Information (Clients #1 - Client #2)

LIC 602: Physician's Report for Community Care Facilities (Clients #1 - Client #2)

LIC 625: Appraisal/Needs and Services Plan (Clients #1 - Client #2)

Medication list for (Client #1 & Client #2)

Staff Training (facility will scan and email staff training to LPA Zina Brown)

Reviewed video surveillance footage of the incident that occurred on 11/17/2024 (requested video to be submitted to community care licensing)

Due to insufficient information available at this time a further investigation is needed.

A exit interview was conducted with Kristen Angeles (Facility Coordinator), and a copy of this report was provided.