Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced Case Management Visit to address additional information obtained during Complaint Control #28-AS-20231229081912 which was investigated by the Department’s Investigations Bureau Branch.

During interviews conducted and record review, Investigator Padilla was made aware of the following:

· There were inconsistent and false statements from both S1 and S2 about the accounts of R1's injuries and who arranged medical transportation for R1. On the Unusual Incident/Injury Report (SIR) that was submitted to CCL, it states that staff observed R1 with their right arm bleeding, and S3 arranged transportation, however, records obtained revealed that R1 called 911 for help themselves to be transported to hospital for further treatment. Facility should have submitted an addendum to their SIR to provide this updated information.

· On an unrelated incident, Investigator Padilla was informed during interviews that R2 had been without a room for 2-3 days because their roommate became aggressive with R1 and kicked R1 out of the room. This was confirmed by S4 who found R1 sleeping on the floor. During interview with R2 Investigator confirmed this information and observed R2 with a few bags in the facility hallway. S1 also confirmed that the two residents were having issues, and S1 was working on getting R2 a new room.

· There was an incident that occurred where S1 was involved in a physical altercation with R1's family member and S1 sustained injuries to their eye during the altercation, an incident report was not filed for this incident and police was called.

Based on investigation conducted by IB Investigator, along with interviews and statements with Staff and Residents, the following deficiencies listed above are being cited on the attached LIC 809-D.

LPA did not observe any health and safety concerns during today’s visit.

Exit interview was conducted, a hard copy of this report and appeal rights were provided to Maria Razo.