Facility Evaluation Report
On 12/09/2022 at 2:35PM, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to conduct a case management visit regarding an incident report received on 12/01/2022. LPA met with Caregiver Lisa Ignacio and Administrator Raquel Miranda.
Incident report dated 11/30/2022 revealed that Staff 1 (S1) was accused of pushing Resident 1 (R1). Facility notified R1's responsible party, CCLD and Staff 1 (S1) that day program will be submitting a incident report stating S1 pushed R1 while assisting R1 to the van.
LPA interviewed three (3) of four (4) staff. LPA was not able to interview Resident 1 (R1) due to diagnosis. Interview with Staff 1 (S1) revealed that S1 was assisting R1 to the van for transportation to day program and R1 miss stepped and hurt her leg. Staff 3 (S3) conducted an investigation, it was found to be unsubstantiated.
LPA requested the following documents to be emailed: Staff roster, Resident roster, and training documents for S1.
Exit interview conducted and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction