Facility Evaluation Report

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced case management visit

on 11/21/2024. This visit is to confirm ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL

LPA met with caregiver and stated the purpose of visit. Facility understands this is an

Immediate Exclusion effective 11/21/2024 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.

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