Facility Evaluation Report
On 6-14-23 at 2:05pm, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to conduct a case management visit regarding incidents which occurred on 5-16-23. LPA met with Program Director (PD) Sherry Welker-Loza and explained the purpose of visit. LPA reviewed incident reports dated 5-16-23 and reviewed client records for Resident1 (R1) and R2 as well as Individualized Program Plan (IPP) for resident1 (R1).
Incident #1: On 5-16-23 at approximately 11:14am, R1 eloped from the day program and walked down a nearby street. Based on record review and interview, although staff attempted to follow R1,staff was unable to supervise R1 and was unaware of whereabouts leading to an absence of supervision. Day program notified house manager for R1's facility address as well as police and licensing department. R1 was located at approximately 2:19pm and returned to facility address at approximately 3:02pm. Based on review of R1's physician's report, R1 is unable leave facility unassisted. Additionally, R1's individualized program plan (IPP) states R1 has a history of eloping.
Incident #2: On 5-16-23 according to incident report R2 sustained a fall at approximately 11:28am after experiencing a "seizure like incident (body jerking)". Additionally, incident report stated R2 bumped head on the curb of the sidewalk. Facility staff assessed R2 to determine if R2 was injured and R2 requested to return home. Day program transported R2 back to day program facility and assessed R2 further. At this time, day program staff notice a dime size lump on R2's head and notified R2's facility who arrived at approximately 11:55am to transport R2 back home. Based on interview, R2 returned to program without further incident.
Based on today's case management, citation is issued under Title 22, Division 6. A civil penalty in the amount of $1000 was issued in addition to the citation due to repeat violation within a 12-month period. An exit interview was conducted with Sherry Welker-Loza and a copy of this report was provided to Sherry. Appeal rights provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction