Facility Evaluation Report

11/10/2022 9:45 AM Licensing Program Analysts (LPAs) Rebecca Knight and Shannon Diegoruelas arrived at the facility unannounced to conduct an unannounced case management visit. LPAs met with administrator Laurie Schlottman. The purpose of the visit is to confirm ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL FACILITIES. Prior to initiating the complaint investigation LPAs completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPAs ensured they applied hand sanitizer when entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. Additionally, LPAs were screened by facility staff.

LPAs met with Administrator and stated the purpose of visit. 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.

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