Facility Evaluation Report, 04/27/2023 — Tigertail Adult Home 4, INC., Lancaster CA

On 04/27/2023 Licensing Program Analyst (LPA) Evelin Rios conducted an announced Case Management - Incident visit in conjunction with complaint control # 31-AS-20230420130932. LPA informed Licensee and Administrator the purpose of this visit. LPA received a Special Incident Report (SIR) on 04/27/2023. Facility self reported an incident that was reported to them on 4/26/23. According to SIR staff #1 (S1) witnessed as stated on SIR "physical abuse" done to Client #1 (C1) by staff #2 (S2) on 04/21/2023. According to S1, S2 hit C1 on their back with a mop stick. S1 reported to Staff #3 (S3) who then advised S1 to report it to administrative staff office to report what S1 had witnessed. Administrative staff immediately decided to suspend S2 and have them removed from all Tigertail Adult Home facilities while this allegation is being investigated. As a result, an SOC341 report was submitted to Adult Protective Services on 4/27/23 to report the possible physical abuse to C1. The Palmdale Sheriff Department was also contacted on 4/26/23 to request a formal investigation on this subject. Staff has been notified not to allow S2 into any Tigertail Adult Facilities.

LPA conducted a physical plant tour to ensure the health and safety of the clients in care. LPA did not observe any health and safety issues or concerns at the facility. From 10:20 a.m. to 1:50 p.m. LPA interviewed house manger, Licensee, Administrator and gathered and reviewed records relevant to the SIR. LPA review of records determined S1 was not associated to this facility. According to Licensee and Administrator they believed S1 was fingerprinted, background cleared and was associated to this facility. Administrator stated they will immediately associate S1 through Guardian if they are not associated. LPA reviewed Facility Personnel Report Summary with Administrator and determined S1's name did not appear on the list of associated personnel. Further information is required to determine possible deficiencies.

Copy of report provided. Exit interview conducted.