Facility Evaluation Report

Licensing Program Analysts Steve Chang conducted an unannounced case management visit and met with Health Service Administrator Bill Penrod (BP).

The purpose of today's visit is to deliver immediate exclusion letter for an individual (referred as PC1).

LPA read and explain the immediate exclusion letter to BP that the Department determined that PC1 must not have continued or future contact with clients/residents or presence in the facility constitutes a threat to the health and safety of clients/residents in care. BP agreed and understood that PC1 is not allowed to work, resident or volunteer in the facility. PC1 is not an employee or employed by the facility; he/she was hired by resident as Private Caregiver through a Home Care Agency (HCA).

Exit interview was conducted with BP. The report was provided to BP for review and signature. A copy of this report and the exclusion letter for PC1 were provided to BP.