Facility Evaluation Report

At approximately 9:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Other visit, and met with Staff Member, Ashley Dillard. Residential Supervisor Georgiamae Wallace arrived during visit at approximately 10:15AM, and Program Director, Priscilla Hernandez, arrived during visit at approximately 11:00AM. The purpose of the visit is to follow up on a self-reported incident submitted to Community Care Licensing (CCL), and to obtain signatures for an amended document.

LPA, Residential Supervisor, and Program Director discussed the following:

Incident report received by CCL on 12/12/2022. Incident report states that on 12/04/2022, Client 1 (C1) reported to facility staff that they were having difficulty breathing, and requested for their inhaler. Staff were unable to locate device and contacted Emergency Personnel. Emergency Personnel conducted their assessment and determined that C1 did not need further assistance. C1 was advised to get rest.

Per conversation with Residential Supervisor and Program Director, C1 is doing fine and has had no further incidents.

Amended document and signature for facility visit conducted on 12/02/2022

Exit interview conducted. Copy of report, LIC 811 (Confidential Names), and amended document discussed and provided to Program Director. Signature on form confirms receipt of documents.