Facility Evaluation Report

On 06/25/25, Licensing Program Analyst (LPA) arrived at the facility unannounced to conduct a case management visit based on an incident report received on 06/20/25. LPA stated the purpose of the visit and was allowed entry into the facility. LPA met with Program Manager (PM), Connie Irving, to discuss the incident.

Facility reported that on 06/05/25, staff at 1:35 PM while changing Client C1, staff noticed what appeared to be bruises on their left arm and stomach. This initiated a body check and staff observed red marks on both legs and their left foot/ankle region was swollen. On 06/14/25, Licensee of C1's home reported to PM that C1 has a fractured Tibia. C1 lives in an Intermediate Care Facility that is not licensed by the Department. There was a notable change of condition for C1 on 06/05/25 and 06/10/25. Reporting was not sent to CCL until 06/20/25.

Based on the information received and per CCR Title 22, the following deficiency is being cited on the attached LIC 809D. If not corrected, this poses a potential risk to the health safety or personal rights to the clients in care. An exit interview was conducted and plan of correction was developed with PM with a due date of 07/18/25. A copy of this report and appeal rights were provided to PM.