Facility Evaluation Report

On 05/02/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced case management visit to the facility listed above for an incident reported to Community Care Licensing (CCL). During today’s visit LPA met with Administrator, Shannon Hamling, and the purpose of today’s visit was explained. There are five (5) clients residing in the facility and three (3) were present during today’s visit.

CCL received a special incident report (SIR) on 05/01/24 stating on the morning of 04/29/24, Staff S2 and S3 entered the room of C1 and observed Staff S1, a 1 on 1 caregiver, shirtless and asleep in Client C1’s bed with C1 in it.

During today’s visit, LPA toured the facility, interviewed Staff (S2 - S4), interviewed Client (C1) with conservator, interviewed C1’s conservator, and received documents pertinent to the incident. The documents include C1’s Physician Report, Needs and Service Plan, Harbor Regional Center Individual Person-Centered Plan, Harbor Regional Center Quarterly Progress Report, and Staff S1 Personnel File.

During today's visit no deficiencies were observed or cited.

An exit interview was conducted with Licensee, Pamela Broderick, and a copy of this report was provided.