Facility Evaluation Report

On 04/10/2025 at 2:30 PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management concurrently with Complaint investigation (15-AS-20250121113617) visit. LPA met with Executive Director, Jon McCraw, and explained the purpose of visit.

During a complaint investigation ( 15-AS-20241025150045 ), LPA obtained and reviewed the following records for Resident (R1): Preplacement dated 8/30/2023, Appraisal dated 8/30/2023 and Physician's Report dated 08/28/2023 with an diagnosis of Mild Cognitive Impairment (MCI). Additionally, LPA reviewed multiple incident reports where R1 made sexual advances towards two (2) staff (S1 and S2) on 9/28/2023, 12/18/2023, 1/22/2024, 3/12/2024, and 10/11/2024. However, based on record review, LPA did not observe an updated appraisals and medical assessment to address these new behaviors. There is no indication in the preplacement and reappraisal from 8/30/2023 that resident has a history of these behaviors. LPA obtained a copy of an updated medical assessment dated 11/18/2024 where it indicated R1 was diagnosed with dementia.

LPA received an Individual Service Plan (appraisal) from ED on 01/02/2025 for R1.

The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided