Facility Evaluation Report

Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility and met with Caregiver Dillon Williams, to conduct an unannounced case management visit on 08/28/2025. Caregiver and LPA Ratajczak attempted contact with Administrator. Administrator was unavailable during time of visit. The visit is to confirm Orders to Individual for Immediate Exclusion from All Facilities.

LPA served order of immediate exclusion effective 08/28/2025 and explained the "Immediate Exclusion" notice indicating that staff member (S1) cannot be allowed to work, be present and/or live in a CCL licensed facility, or have contact with clients in any residential facility or child day care licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility. Caregiver indicated they understood the notice.

Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these forms.