Facility Evaluation Report

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to follow up on an incident. LPA initially met with DSP Angelica Punu. Administrator Roxanne Arcibal was phoned during the visit. Licensee Monaliza Dela Rosa and Administrator Arcibal arrived shortly.

On June 24, 2022, the Department received a report on Client 1 (C1). A review of incident reports revealed staff failed to submit an incident report to the Department. LPA Bueno requested a copy of the incident report from Administrator Arcibal and it was provided by email on this day. Additionally, LPA was informed the incident report had not been submitted to the Department.

The incident report revealed the incident occurred on 06/21/2022. The report stated that local law enforcement was called to the home and a report was taken. Facility staff do not have a copy of the police report but did provide the report number. Staff interviews revealed that the responding officer toured the home and subsequently found the call was unfounded.

Refer to LIC809D for deficiency cited. An exit interview was conducted where a copy of this report, LIC809D, and appeal rights were discussed and provided to the Administrator Arcibal.