Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to issue a deficiency which was identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Site Coordinator Michelle Islas .

Per records and interviews, Licensee was made aware of each of the following allegations, on or near the dates listed: a) An allegation from Client #1 (C1) that Staff #1 (S1) inappropriately touched Client #2’s (C2) leg on the day program van on 10/13/2023, b) An allegation from C2 that S1 inappropriately touched C2’s leg on the day program van on 03/10/2025, and c) An allegation from C1 that that S1 made an inappropriate sexual comment to them on 06/24/2025. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] The allegations were serious enough to warrant Licensee's internal investigation of each.

Records and interviews showed that for the 10/13/2023 touching-allegation involving C2, Licensee timely notified C2’s conservator, Adult Protective Services (APS) and submitted a Special Incident Report (SIR) to C2’s San Diego Regional Center (SDRC) Coordinator, as required. However, Licensee did not submit a written report to CCLD within seven (7) days, as required. Regarding the 03/10/2025 touching-allegation involving C2: Records show C2’s conservator was made aware of the incident. However, Licensee did not notify APS, SDRC, and CCLD, and no written report was submitted to these agencies. Regarding the 06/24/2025 sexual-comment allegation involving C1: Records show C1’s responsible person was quickly aware of the incident. However, Licensee did not notify APS, SDRC, and CCLD, and no written report was submitted to these agencies. [CONTINUED ON LIC 809-C]