Facility Evaluation Report

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced case management and met with staff Devon Seaverbrosh. The purpose of the case management visit was to obtain additional information regarding incident report due to elopement of client C1 that occurred on March 17, 2022 - facility reported to the Department on the same day.

LPA interviewed Angeline Kimbo administrator on March 17, 2022. Per administrator, AM shift had just got to the facility - facility staff were switching shifts - went to check on client C1 and client wasn't in the bedroom. Facility staff looked around the house and didn't find C1. When 2 care staff went to downtown Novato, they found client C1 at encampment on a tent with a guy possibly doing drugs. Client C1 ran out of the tent into the street - police was on site. Client C1 has returned since the episode. Client C1 was asleep during this visit, C2 was with another staff in the living room/kitchen, and C3 was asleep. Client C1’s physical assessment dated September 29, 2021 is incomplete – page 2 has no information noted by doctor regarding client. (see LIC 809-D) However, Behavior Assessment and Support Plan dated September 2021 states “Target Behavior #2 AWOL”. Furthermore, on March 16, 2022 facility had 3 staff on NOC shift - 1 lead staff (RBT), 1 staff trained on behavior (RBT), and 1 direct care staff (DSP).

LPA arrived at the facility and was welcome by staff. There were 5 staff and 4 of them were not wearing a mask. Staff S1 stated that she was drinking – believed to be a cold drink. LPA asked the other staff why they were not wearing a mask. Staff didn’t answer and placed their masks on. (see LIC 809-D)

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.