Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of following up on the death of Client #1 (C1) which occurred while client was under the care of another licensed facility on October 7, 2024.

During today's visit, LPA interviewed Administrator Paul Chea, C1's Behavior Specialist, and two caregivers on duty. LPA reviewed and obtained copies of the following documentation: Client Roster, Personnel Report Summary, Medication Administration Records, Physician's Report, IPPs, CDER, and other pertinent records.

LPA toured the interior and exterior of the facility. LPA observed the facility's utility to be working. LPA observed three roaches at the time of the visit. LPA received a copy of the service agreement with Western Exterminator which is to begin October 16, 2024 per Administrator. Facility will be serviced on a quarterly basis. Facility maintains a 2-day supply of perishable and a 7-day supply of non-perishable food in the kitchen and garage. Medications, sharps, toxins, and cleaning supplies were secured and inaccessible to the clients. Certificate of liability insurance remains current.

During today's visit, no imminent health and safety violations were observed and no deficiency is being cited. A Technical Violation is being issued.

An exit interview was conducted with Administrator Paul Chea, and a copy of this report was provided at the end of the visit.