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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004764
Report Date: 06/06/2024
Date Signed: 06/06/2024 03:26:44 PM

Document Has Been Signed on 06/06/2024 03:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EPJ'S CARE HOMEFACILITY NUMBER:
397004764
ADMINISTRATOR/
DIRECTOR:
MARYANN PATACSILFACILITY TYPE:
735
ADDRESS:6864 PERSHING AVENUETELEPHONE:
(209) 477-5247
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 6DATE:
06/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:21 PM
MET WITH:Ernesto PatacsilTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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On 6-6-2024 at 2:21pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding an incident which occurred on 5-12-24. LPA met with Administrator Ernesto Patacsil and explained the purpose of the visit. LPA conducted brief interview with Administrator and staff1 (S1), and reviewed incident report dated 5-13-24 with Administrator. LPA also reviewed individualized program plan (IPP) for resident1 (R1) and physician’s report for R1.

Based on interview and record review, it was determined that on 5-12-24 at approximately 3:30pm, R1 became upset over an issue regarding a request for a new cell phone. R1 then entered his room at approximately 5:15pm after speaking with staff. At approximately 5:45pm, facility staff discovered R1 was not in his room. Facility staff immediately began searching throughout facility inside and out, and while searching R1 was observed by facility staff being escorted to facility by law enforcement officer at approximately 6:00pm. It was determined that R1 was found within one block of facility sitting on the sidewalk. R1 was returned with no injuries and facility staff continued to monitor R1 for any escalation of exit seeking. Facility staff protocol is to notify local law enforcement within one hour after discovering a resident missing and facility staff search. R1 returned within to this time frame. A review of R1’s physician’s report states R1 is able to leave facility unassisted. Interviews and record reviews revealed R1 has a history of attempting to exit seek.

As a result of today’s case management, no citations are issued. An exit interview was conducted with Ernesto Patacsil and a copy of this report was provided to Ernesto.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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