Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility to conduct a case management. LPA met with Licensee Kevin Clark and stated the purpose of this visit

On June 7, 2021, Community Care Licensing Division (CCLD) Orange Office received a complaint no. 22-AS-20210607162452 filed against this facility. During the course of the investigation, LPA observed that the facility had filed three separate incident reports with Regional Center of Orange County. The three incidents involved Client 1 happened on May 7, 2021, May 18, 2021, and May 19, 2021. Per file review, LPA did not observe that CCLD received any of the above reports from the facility.

For this visit, deficiency was observed, and citation was issued per Title 22, Division 6 of the California Code of Regulations.

LPA Marin conducted an exit interview with Licensee Clark. LPA discussed the deficiency, citation, and appeal rights. Copies of this report, 809 D (Deficiency), appeal rights, and cited regulation were left in the facility.