Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced at Pennsylvania Care Home and met with DSP staff Tony Legaspi. Co-Administrator Virginia Punzalan arrived later. The purpose of this case management inspection is to follow up on an incident which was self reported by phone and an incident report was received by Community Care Licensing (CCL) on 11/15/2021.

The following was reported: On 11/11/2021 at approximately 7:14 PM Client (C1) left the facility to the nearby store to buy something and meet with friends. C1 did not return on 11/11/2021 to the facility, but staff stated C1 would sometimes spend the night at a friend's home. Staff (S1) was going to contact law enforcement the following day when two police officers arrived to the home to inform the facility of an incident that occurred which resulted in C1 being fatally shot. C1's responsible party, North Bay Regional Center Service Coordinator, and CCL were notified of the incident.

During today's inspection LPA requested and obtained copies of documents for Client (C1) and other clients in the home (C2, C3, C4).

Exit interview was conducted with Co-Administrator Virginia Punzalan whose signature below confirms receipt of report.

No deficiencies cited during today's inspection.