Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced, subsequent Case Management visit to cite a deficiency resulting from an investigation conducted on an incident self-reported by the licensee. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Chief Executive Officer Debra Emerson. LPA also met with Director of Programs Thomas Carr, who arrived later during the visit.

On 02-02-2023, the CCLD San Diego Regional Office received an LIC624 Unusual Incident Report from licensee. Per the LIC624: during a 01-25-2023 outdoor hiking activity chaperoned by Staff #1 (S1), Client #1 (C1) became separated from the group and was missing for “at least 30 minutes.” [See LIC811 Confidential Names List for a description of person identifiers used in this report.] The report said law enforcement subsequently located C1 and returned them uninjured to staff. CCLD’s investigation involved a facility tour/welfare check, review of pertinent care and administrative records, and interviews of C1 and relevant staff and outside sources.

According to C1’s LIC602 Physician’s Report: C1 was developmentally delayed and their doctor determined that they were not able to safely leave the facility unassisted. According to the Individual Service Plan (ISP) licensee authored, C1 required “constant supervision from staff.”