Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Staff Virginia Pacheco. LPA then met with Administrator Michelle Wojciechowski, who arrived later during the visit.

Today's visit was in response to an LIC624 Unusual Incident/Injury Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 05/25/2023). According to the LIC624: During a community outing on 05/21/2023, Client #1 (C1) was briefly left unattended by staff; they did not suffer any harm or injury as a result. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report]

During today’s visit, LPA performed a facility tour / welfare check, verifying that C1 and other clients in care were safe / unharmed. LPA also collected copies of pertinent records and interviewed relevant clients and staff.

During the visit, LPA sought to examine C1’s LIC602 Physician’s Report (or equivalent medical assessment), but the licensee did not possess such a document on C1 (which was confirmed by the administrator).

According to C1’s Face Sheet and San Diego Regional Center (SCRD) Client Placement Referral (dated 02/09/2022): C1 was diagnosed with “mild intellectual disability.” Staff interviews revealed that while C1 was a high-functioning client, they were not safe to be in the community without staff supervision.