Facility Evaluation Report

Licensing Program Analysts (LPAs) Huma Rahimi and Lorena Casillas conducted a subsequent unannounced visit to the facility in conjunction with complaint control # 31-AS-20250828113316 . Upon arrival, LPAs met with Staff #1 (S1) , who granted access to the facility. The Licensee was contacted by the LPAs and were informed that the Administrator would be unable to join LPAs due to an appointment. LPAs explained the purpose of the visit and the Licensee arrived shortly after at 11:15 AM.

On September 2, 2025 , LPA Rahimi conducted an initial complaint visit and was informed that approximately the last week of June 2025, a former staff member allegedly restrained Resident #2 (R2) which caused discomfort and pain in the presence of a witness . LPA interviewed the witness, who confirmed that the former staff member did, in fact, restrain R2 , causing R2 to experience pain. LPA was informed that it was reported to the Licensee and the staff member was immediately fired and is no longer working at the facility. However, no incident report was submitted to the Community Care Licensing Department (CCLD). LPA reviewed all incident reports submitted through CCLD internal system and did not observe an incident report regarding this particular incident with R2. In addition, during today's visit, the Licensee admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPAs informed the Licensee that all staff members are mandated reporters and they are all responsible for reporting.

LPAs informed the Licensee to submit an incident report that occurred on or before :

Last week of June, 2025. Continue on LIC 809C