Facility Evaluation Report

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Case Management visit. LPA identified themselves to the Deseray Sandoval, Staff

and we discussed the purpose of the visit. Sally Saif, Administrator arrived during the visit.

Today's visit is in response to the AWOL of Client 1 (C1) date of incident: August 3, 2024. The facility properly reported C1 going AWOL. The facility's Missing Persons/Absentee Notification Plan was reviewed on this date with the Licensee. C1 was away from the facility for about 10 minutes unsupervised and was returned safely to the facility by staff. Staff found C1 down the street with an unidentified male and they walked C1 back to the facility. C1 requested an ambulance and PERT and so the staff called PERT and they were the ones that took C1 to the hospital. C1 went to the hospital for one day and returned on Sunday. C1 went to program on Monday and told all of the staff what they did while they were AWOL. LPA conducted interviews on this date. According to C1s latest physicians report dated 07/03/2024 it states the client can leave the facility unassisted. LPA received copies of pertinent information regarding C1.

No deficiencies were cited or observed on this date.

An exit interview was conducted with the Administrator. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Saif at the conclusion of the visit.