Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada conducted an unannounced case management visit on March 27, 2026. This visit is to confirm ORDER TO LICENSEE/FACILITY FOR IMMEDIATE EXCLUSION FROM FACILITY.

LPA meth with Jacob Moore, Nursing Director, and stated the purpose of visit. LPA provided the Nursing Director with a copy of the above order. Facility understands this is an Immediate Exclusion effective March 27, 2026 and (S1) is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility 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.

The Nursing Director stated (S1) has not worked at the facility since on/around early/mid May 2025. Facility will update their employee roster in the Department's Guardian system.

Exit interview conducted, a copy of this report provided on this date. A signature on these form acknowledges receipt of these form.