Facility Evaluation Report

Licensing Program Analysts (LPAs) Julie Florio and Star Stevenson arrived unannounced to conduct a Case Management - Deficiencies Inspection. The purpose of this case management visit was to follow up on a self reported incident report that was submitted to Community Care Licensing (CCL) on 11/08/2024 regarding client C1 as well as to cite deficiencies for regulatory violations observed during today's inspection.

During visit LPA went over incident details, gathered records, took statement from Facility Director, and made observations. Per review of today's records and interviews, staff addressed the incident as needed, when it occurred. Further, LPAs were informed that the aggressor in the situation reported has been discharged from C1's Day Program and they no longer have interactions.

Additionally, during today's visit LPAs observed the following areas of noncompliance, (see LIC809D):

Missing Pre-placement Appraisal for all clients in care; no operational designated facility telephone; no designated responsible party present in facility; and administrator not present a sufficient number of hours to ensure facility is maintained and operating in compliance with regulation(s).

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview was conducted with Facility Director. Copy of report discussed and provided to Facility Director. Signature on form confirms receipt of documents.