Facility Evaluation Report

Licensing Program Analyst (LPA) Jey Cardenas conducted a case management visit to the above facility due to during a complaint investigation control number 11-AS-20211215111839 LPA observed deficiency not related to the complaint allegation. LPA met with Staff#3 and Conducted a Covid-19 risk assessment.

During complaint investigation LPA Cardenas observed C1 wearing a protective device; helmet for safety purposes. Per IPP Dated: 10/07/2020 C1 is diagnosed with profound intellectual disability, psychosis, and Impulse control disorder. Goals include reducing instances of injuring self, being physically aggressive, removing clothes, spitting, smearing saliva, and emotional outbursts. Emotional outbursts include screaming, yelling, jumping, falling on the ground and or/ tearing paper or breaking items. C1 exhibits self injurious behaviors like slapping/ hitting self, picking at face, fingers, chest, and stomach, as well as scratching or biting lips.

Bessie Coello indicates that numerous meetings have been taking place with C1's support team and are in agreement for the use of helmet.

On today 6/17/22 LPA Cardenas is issuing a deficiency due to LPA has not obtained written requests to use protective devices on C1.

Exit interview conducted, a copy of this report provided to staff, deficiency entered on LIC809D report and appeal rights provided.