Facility Evaluation Report

At approximately 10:15 AM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a Case Management - Incident Visit and met with House Manager - Lourdes Soller. The purpose of the visit was to follow up on a self-reported incident that occurred on 08/11/2025 as was submitted to Community Care Licensing (CCL) on 08/15/2025

Incident Report 1: Client 1 (C1) became agitated with client 2 (C2) and was going in and out of the home before ultimately breaking open a magnetically locked knife drawer in the kitchen resulting in a call to local police and ultimately C1 being taken to the hospital.

Facility has since purchased an electronic coded deadbolt for a solid pantry door cabinet and now have the knives secured in this area. In addition, their handyman is in the process of adding a keyed lock with metal latch to an additional drawer, nearing the food prep area of the kitchen (Upon my arrival I see lock components and tools out.)

Facility made all appropriate notifications per regulation.

Exit interview conducted. Copy of report discussed and provided to House Manager Lourdes Soller.

Signature on form confirms receipt of documents