Facility Evaluation Report

01/31/2023 10:30 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct an unannounced case management visit. LPA met with administrator Dawn Jackson. The purpose of the visit is to confirm that an excluded individual, Staff 1 (S1), is not currently working at the facility. Prior to initiating the complaint investigation LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer when entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. Additionally, LPA was screened by facility staff.

LPA met with Administrator Dawn Jackson and stated the purpose of visit. Facility confirmed the receipt of the Immediate Exclusion effective 11/10/2022 that states 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. The facility understands that S1 cannot be physically present in the facility. LPA toured the facility and confirmed the excluded individual, Staff 1, was not present.

Exit interview conducted, a copy of this report provided to the administrator.