Facility Evaluation Report

At approximately 3:20 PM Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Case Management - Incident visit. LPA was greeted by Herby Mathurin, Licensee/Administrator. LPA informed Licensee the purpose of today's visit was to investigate a suicide threat by Client 1 (C1) as reported via incident report (IR) dated 12/05/2024. LPA requested copies of C1's most recent medication list, and notes from all of C1's hospital visit, IPP, ISP, and any psychiatry visit notes.

During visit LPA made observations, went over incident details, gathered records, and conducted an interview with Licensee. Per review of records obtained and interview, staff addressed the incident as needed, when it occurred.

Facility made all appropriate notifications per regulation.

Exit interview conducted. Copy of report and LIC811 (Confidential Names) discussed and provided to Administrator/Licensee. Signature on form confirms receipt of documents.