Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with DSP Josephine Rocamora. LPA also spoke via phone with Licensee Emerita Garcia during the visit.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 12/22/2023), involving Client #1 (C1). [See LIC 811 Confidential Names List for a description of person identifiers used in this report].

During today’s visit, LPA performed a facility tour and welfare check on clients in care, finding no immediate safety concerns. LPA also reviewed pertinent care records and interviewed the clients present and relevant staff.

No deficiencies were cited for the incident itself. However, during records review, LPA observed: a) Licensee did not possess a written Functional Capabilities Assessment for C1, as was required; b) Licensee did not possess a written Needs and Services Plan for C1 (or other equivalent care plan), as was required; and c) Licensee did not maintain a written Absentee Notification Plan as part of C1’s record of care, as was required. Licensee interview confirmed these points to be true.

Two (2) deficiencies were cited per California Code of Regulations, Title 22, and one (1) deficiency was cited per California Health and Safety Code (refer to the attached LIC 809-D pages). Plans of Correction was jointly developed with the licensee.

An exit interview was conducted with Rocamora. A copy of this report, the LIC 809-D pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to Rocamora and Garcia during the visit.