Facility Evaluation Report

Licensing Program Analyst (LPA) Kayla Hilario conducted an unannounced Case Management Visit. LPA was allowed entry and met with Administrator Kim Pollard. LPA identified herself and discussed the purpose of the visit.

Today's visit is in response to the self-reported incident which occurred on 06/04//2022 regarding an AWOL of Client 1 (C1 - see LIC811 Confidential Names List).

LPA conducted a wellness check at the facility by touring the facility, observing that clients in care appeared appropriate for the facility, interviewing staff, and collecting client records.

According to the Special Incident Report (LIC 624), C1 went AWOL on Saturday 06/04/2022 during the afternoon. Licensee did not follow the Absentee Notification Plan as recorded in the Facility Plan of Operations which states that staff will contact the police department within two hours of a client being missing. Interview with staff confirmed that C1 did not return to the facility at teh designated curfew hour on 06/04/2022. Staff interview confirmed that police department was not contacted. C1 did not return to the facility until Sunday 06/05/2022 at 8:19 p.m.

Based on facility records and interviews, deficiencies were cited during this visit of Health and Safety Code 1507.15. An 809-D page is attached to this Facility Visit Report.

LPA amended 809D page on site during the visit to include signatures. An exit interview was conducted with the Administrator Kim Pollard. A copy of this report and appeal rights (LIC9056 01/16), were provided via hardcopy.