Facility Evaluation Report

06/30/2026; Licensing Program Analyst (LPA) Loera arrived unannounced to conduct a Case Management - Incident visit and met with Administrator, Dae Harris. The purpose of the visit was to follow up on a self-reported incident that was submitted to Community Care Licensing (CCL).

CCL received an incident report on 05/08/2026. Report states on 05/07/2026 during medication pass client (C1) came to the med room stating that their lips were swollen and tingling. Staff observed C1's lips and seen that their bottom lip was swollen. Staff asked C1 what did they eat or do differently, C1 said shrimp for lunch and fish for dinner. C1 was taken to Sutter Solano.

Per conversation with Administrator, C1 did not have a history of fish allergies prior. It was discovered after C1 ate fish and shrimp that they were allergic.

LPA obtained copies of medical documentation.

Exit interview conducted. Copy of report and LIC811 (Confidential Names) discussed and provided to Administrator.