Facility Evaluation Report

06/16/2022 9:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Dawn Jackson administrator for the facility. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask, gloves. The purpose of this visit was to conduct a case management inspection to confirm that an excluded staff was not present at or working in the facility.

The Order To Individual of Immediate Exclusion letter was issued on Jun 2, 2022 to Staff 1 (S1). S1 was associated to the following facilities:

LPA spoke to administrator and explained the "Immediate Exclusion" notice indicating that S1 cannot be allowed to work, be present and/or live in a CCL licensed facility and have contact with clients in any residential facility or child day care licensed by the California Department of Social Services. Administrator Dawn Jackson indicated they understood the notice and confirmed with HR Kelly Maxwell ithat S1 was officially terminated from employment on 5/07/2022.

Administrator agrees to submit signed letter to LPA Knight by close of business 06/16/2022 that states that S1 is no longer employed by the facility.

Exit interview completed. Copy of report was emailed to administrator Dawn Jackson.