Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted a Case Management- Incident visit to follow up on an incident report dated 4/9/2025. The purpose of the visit was explained to House Manager Efren Quintero. The purpose of today's visit is to check on the health & safety of residents in care, interviews, and record review.

Three staff were interviewed. Staff (S1) denied the incident. Resident (R1) denied the incident.

The incident report alleges resident (R1) had a discoloration mark on the right wrist. The resident accused staff (S1) of making the mark.

On 4/9/2025, Administration staff opened an investigation. Staff (S1) was suspended on 4/9/2025, pending investigation findings. Staff returned to work on April 15, 2025, the abuse findings were not substantiated.

Based on record review and picture evidence, the findings indicate R1 has history of self harm, story fabrication, and aggressive behaviors. There is inconclusive evidence to confirm the injury was caused by S1.

NOTE: Administrator did not submit to CCL an SOC 341 Report of Suspected Dependent Elder Abuse incident report; only an incident report was received. Please submit by tomorrow.

Exit interview conducted and a copy of the report was given to House Manager Efren Quintero.