Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite a deficiency identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Jane Antonio.

Interviews of outside sources and facility staff widely corroborated that on 06-17-2024, Client #1 (C1) sustained multiple fresh scratches on their face. The scratches were not bleeding and did not require medical attention, but they were reddened, visible, and significant enough to require both internal and external investigation.

Records review, corroborated by manager interview, showed: Licensee initially did not report C1’s 06-17-2024 incident to CCLD. Rather, the Department learned about the incident from a concerned third-party well after seven (7) days had passed.

One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Antonio, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.