Facility Evaluation Report

On 10/4/2022 at 2:00 PM, Licensing Program Analyst (LPA) L. Ibo conducted an unannounced Case Management in regard to Special incident report (SIR) received on 9/29/2022. Based on SIR, C1 engaged in dangerous behavior during a community outing with staff and another client. LPA met with Administrator Tiffany S. and explained the purpose of the visit.

LPA toured the facility inside and outside. LPA met with C1 and asked her few questions. LPA observed C1 was smiling during the interview, C1 stated she is “doing good”, C1 offered LPA if C1 can show her bedroom, LPA checked C1's bedroom. LPA did not observed any injury on C1 in related to the incident.

LPA interviewed Administrator, based on interview, C1 was out for shopping with 3 staff and another client, C1 cannot find the toy that she was looking for that is when C1 started to engaged in dangerous behavior. Staff was trained on how to handle C1’s behavior, 911 was called, C1 was placed on 72 hours hold at the hospital. Facility staff is continuing to monitor C1 at the facility and there is one on one staff in place.

Exit interview conducted with Administrator . A copy of report provided to care staff.