Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho made an unannounced Case Management visit for the purpose of of conducting a health and safety inspection. LPA met with Care Staff Rodney Monge and notified Administrator Laura Palomino by telephone the reason for the visit.

During the inspection, LPA toured the facility with Care Staff Monge. LPA observed two staff and observed three clients present as one client had already left to program. LPA confirmed Staff #1 (S1) is not present and employed at this facility. LPA conducted a health and safety check on the clients present and confirmed all were doing well. LPA observed the facility to be clean and organized. LPA observed facility has a 2-day supply of perishables and 7-day supply of non-perishable food as required by regulation including emergency food and water. LPA observed the electricity and water running, facility maintained soap and paper towels, medications/sharps/toxins were properly secured and stored. The fire extinguisher was serviced on September 3, 2024. The smoke and carbon monoxide detectors were tested and operational.

LPA requested copies of the client/staff records to be submitted to the Department for review by 1pm on August 27, 2025: Client Roster, Personnel Report Summary (LIC500), Face Sheets, Identification and Emergency Informations (LIC601s), Admission Agreements, current Individual Program Plans (IPPs) and/or Client Developmental Evaluation Reports (CDERs), Physician's Reports (LIC602s), Behavioral Services Reports, and Client #1 (C1's) Progress Notes and Behavior Charting. For Staff #1's (S1's) records: Photo Identification, Personnel Record (LIC501), Background Clearance, Confidentiality Agreement, Sexual Harassment Policy, Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders (SOC341A), Criminal Record Statement (LIC508), and current training records.