Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza is conducting a case management visit in conjunction with a complaint that has the control #28-AS-20240618110757. LPA met with Isidro Serrano, Direct Support Staff (DSP) for the facility, and explained the purpose of the visit. Administrator Gilbert Cardenas was notified of the visit by phone call.

During the investigation for the complaint, it was revealed that Client #1 (C1) sustained a Serious Bodily Injury (SBI) due to an interaction that they had with Staff #4 (S4). It was revealed through documentation from C1's hospital discharge paperwork that C1 was diagnosed with a broken right clavicle due to this altercation. S4 stated that on the date of the incident there was a physical altercation during which C1 lunged at them. S4 stated that they extended their arms outwards in order to create distance between them, and this caused C1 to stumble and fall backwards onto a night stand drawer, and therefore this was an accidental injury done in self-defense. The facility used Crisis Prevention Intervention (CPI) based on the Facility Behaviorist Report for instances in which clients engage in aggressive behavior, and it did not appear that a proper CPI hold was utilized during this incident. Because the violation resulted in the SBI of C1, and was the result of an inappropriate response to client behavior, deficiencies are warranted in response to this incident.

Immediate Civil Penalties will be issued today, in the amount of $500.00 due to C1 sustaining a Serious Bodily Injury as a result of their broken right clavicle. Refer to LIC421IM.

At this time an Enhanced Civil Penalty (ECP) determination is pending in reference to Health and Safety Code 1548(f)(1)(A) and may be assessed at a later date.

Exit interview held. A copy of the LIC9099, LIC9099C, and LIC421IM (Civil Penalty Assessment), and Appeal Rights were provided to Isidro Serrano and will be forwarded to the administrator Gilbert Cardenas.