Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management to follow up regarding an incident which occurred where client (C1) went missing while attending the day program. LPA Rai met with Program Director, Ruby Duran and stated the purpose of today's visit.

On 9/3/2024, C1 and three other clients went to the local library as part of the community activity scheduled for the day. Staff (S1) was supervising the 4 clients at the library. While at the library, C1 left the library. At this time, C1 has not returned back to the day program or C1's residential facility.

During today's visit, LPA Rai interviewed Program Director and Staff (S1). Clients were not present at the facility.

Program Director stated she did not report the incident since it had occurred out in the community and the incident did not occur in the facility. LPA Rai stated if the client is attending day program and is out in the community due to a scheduled activity, then it is the responsibility of the day program to report the incident since the client was under the care and supervision of the day program staff. Program Director agreed and understood. During today's visit, LPA Rai issued a deficiency due to the facility staff did not notify licensing agency regarding C1 leaving the library which was a scheduled activity while attending day program.

LPA Rai determined that this case management require further investigation to obtain additional information.

Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Plan of Correction (POC) for Type B deficiency issued during today's visit will be due on Thursday, September 12th, 2024. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Program Director, Ruby Duran and a copy of the report was provided. Appeal Rights were provided.