Facility Evaluation Report

Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management visit to follow up on two self- reported incidents, received by Community Care Licensing on 6/15/22 and 7/8/22. LPA was greeted and granted entry into the facility by Mayreni Olea, Program Administrator, with whom she discussed the purpose of the visit.

On 7/8/22, the facility submitted a self -reported incident regarding Client 1 (C1) pushing Client 2 (C2) (See LIC 811 Confidential Names to identify C1 & C2) that occurred on 7/6/22. C1 and C2 were outside in the courtyard area during the morning facility staff huddle. C1 was observed by Staff 1 (S1) and Staff (S2) (See LIC 811 Confidential Names to identify S1 & S2) extending their arms outward and pushing C2 forward onto a bench and onto the lap of Client 3 (C3), who was sitting on the bench. The push resulted in C2 scraping their knees on the ground and sustaining scrapes to both knees. S1 applied first aid immediately. C1 was immediately redirected and both clients were taken into their classrooms. Program Administrator stated that facility staff will assure that C1 and C2 are kept apart from each other. Program Administrator notified all appropriate parties. The El Cajon Police Department was contacted on their non-emergency phone line to report the incident. LPA conducted interviews with Program Administrator and facility staff. No deficiencies were cited regarding this incident.

On 6/15/22, the facility submitted a self - reported incident regarding Client 4 (C4) (See LIC 811 Confidential Names to identify C4) missing two doses of two separate medications at 12:00pm on 6/13/22. It was reported that Staff 3 (S3) (See LIC 811 Confidential Names to identify S3), failed to notify Program Administrator of C4's missed medications that were not taken at 12:00pm on 6/13/22. On 6/14/22, C4's missed medication doses were observed by Staff 4 (S4) from her review of the Medication Administration Record (MARS). S4 reported information to the Program Administrator. Per Program Administrator, she followed up with C4's responsible party and there were no health complications due to C4 missing the two doses of the separate medications. Program Administrator notified all appropriate parties. LPA reviewed client and staff records and Medication Administration Record (MARS). CONTINUED ON NEXT PAGE