Facility Evaluation Report

Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced case management visit to follow-up on an incident reported to Community Care Licensing. LPA introduced herself, was granted entry into the facility, and met with Margarita Gaviola, Licensee, to whom she disclosed the purpose of the visit.

Community Care Licensing received an incident report on February 14, 2022, in which it was reported that Client #1 (C1) [Licensee was provided an LIC 811 Confidential Names List that identifies the client] went absent without official leave (AWOL) from the facility on February 13, 2022 and was returned on February 15, 2022.

During today's visit, LPA conducted a health and safety check of the clients in care, interviewed licensee and C1, provided consultation, and obtained copies of facility records. No deficiencies were cited during today’s visit.

An exit interview was conducted with Margarita Gaviola, and a copy of this report and Licensee Appeal Rights (LIC 9058) were provided to the licensee, via electronic mail, following the visit. An electronic mail read receipt confirmation was requested to be sent to LPA upon receipt of the documents.