Facility Evaluation Report

Licensing Program Analyst (LPA) Walters and IB investigator, Brianna Abeyta (BA) arrived unannounced to follow up on a self-reported incident. LPA and BA were greeted by Administrator, Jacqueline Hicks.

The facility self reported on 4-14-22, that staff S1 and S2 were assigned to provide care and supervision for client C1, however when Administrator arrived to the facility on 4-14-22, The Administrator learned that C1 was without supervision. The facility submitted an incident report regarding the incident and the Administrator provided a statement. Staff S1, resigned and Staff S2 was taken off of their shifts, pending the investigation. In review of C1's Individual Behavior Support Plan and Treatment Plan, C1 requires 1:1 supervision for support.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Jacqueline Hicks, Administrator, who's signature below confirms receipt of report.