Facility Evaluation Report

Licensing Program Analysts (LPA) Kevin Mknelly and Rebecca Knight conducted an unannounced case management visit on 12/7/2022. This visit is to confirm ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL FACILITIES.

LPAs completed required COVID-19 daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPAs completed a facility risk assessment upon arrival. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. Additionally, LPA was screened by facility staff upon entering the facility.

LPAs met with Caregiver, Robin Howell and stated the purpose of visit. LPA Mknelly spoke with licensee, Kathy Holliday , by phone. Facility understands this is an Immediate Exclusion effective 11/10/2022 and S1 is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility. S1 is reported to have moved out of the area.

In addition to the exclusion notifications, LPAs amended complaint findings issued on 7/22/21 for complaint control numbers 25-AS-20210329124631 and 25-AS-20210311144929 for allegations Staff handled resident in a rough manner and Facility staff members handled resident in a rough manner, respectively, based on new evidence,findings to be changed from Unsubstantiated to substantiated.

Exit interview conducted, a copy of this report provided on this date. A signature on these forms acknowledges receipt of these forms.