Facility Evaluation Report

Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a case management incident visit and met with CEO Samson, Evelyn. The purpose of this case management visit is to conduct a follow up visit on an Special Incident Report (SIR) submitted to Community Care Licensing (CCL) on 03/19/2025.

Per SIR on 03/17/2025 Client (C1) arrived to Pace Solano Adult Day Program (ADP) with a black circle around their right eye resembling a bruise. ADP noted that C1 did not attend day program from 03/13/2025 to 03/14/2025, or the weekend of 03/15/2025 to 03/16/2025 and returned to ADP on Monday 03/17/2025.

LPA obtained copies of client LIC602's, client care plans and documentation pertinent to SIR submitted by ADP.

Staff was reminded to always submit a SIR for unexpected changes or findings with clients, as well as, educate staff as to the importance of updated care plans regarding client's changing mental and physical condition. Evelyn Samson claims her daughter had sent in an incident report into Community Care Licensing but was not able to locate it during my visit and promises to send a copy into CCL once located or send in a new SIR of the incident.

Today, staff interview were conducted and documents obtained.

Exit interview was conducted with CEO Samson, Evelyn