Facility Evaluation Report

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit to the facility. LPA Lopez identified herself and was granted entry by Sandra Campbell, caregiver. LPA stated the purpose of the visit and reviewed the basic elements of the visit with caregiver Campbell. Celina Brown, Administrator later arrived and joined the visit

The facility self - reported an incident regarding Client #1 (C1) (See LIC 811 Confidential Names List) to Community Care Licensing on September 19, 2022. The facility reported that on September 19, 2022, C1 eloped from the facility but returned to the facility the same day with no injuries noted.

During today’s visit, LPA conducted interviews with staff and outside source, and requested and obtained client records. This case management does require further follow-up. No deficiencies were cited during this visit.

An exit interview was conducted with Administrator Celina Brown and a copy of this report, LIC 811 and Licensee/Appeal Rights (LIC 9058 03/22) were provided to the Licensee at the conclusion of the visit. The signature below confirms the documents were received.