Facility Evaluation Report

Licensing Program Analyst conducted an unannounced case management visit regarding the incident report received on 12/5/25. LPA was met by designated administrator Ninfa Gozon (DADM) and stated the purpose of the visit.

The facility is licensed to serve adults age 18 through 59 who are developmentally challenge (level 4F/5), approved for 15 non-ambulatory, and 6 may be bedridden, all bedrooms are approved for bedridden.

LPA conducted an interview with the staff 2 (S2) and staff 3 (S3), as a follow-up on the incident that occurred on 12/3/25 with resident (R1). R1 eloped while at the Goodwill Store and, was missing for more than 15 minutes and was hit by a car, ended up in the emergency room and sustained an abrasion the the left arm.

LPA collected information regarding staff training after the incident. At this time, this case in under review and department will conduct a follow up visit , if warranted.

No deficiencies were cited during today's case management visit and copy of the report was provided.