Facility Evaluation Report

At approximately 2:20PM, Licensing Program Analysts (LPA) Loera arrived unannounced to conduct a Case Management - Incident Visit and met with Program Manager, Tracey Davis. The purpose of the visit was to follow up on self-reported incident that were submitted to Community Care Licensing (CCL).

Incident Report: CCL received an incident report on 11/1/2024. Report stated that on 10/28/2024, at approximately 9 am while Client (C1) was being assisted in the shower, C1 reached for the handle and slipped on the floor. As a result to the fall, C1 had a laceration on the left side of the head behind his ear. C1 then had another fall around 9:30am, while standing in the kitchen, C1's body became rigid. Staff called 911 and C1 was taken to Kaiser and given a head CT + 4 staples to his laceration. C1 was then discharged at 2:30pm with needing a follow-up, head and neck surgery on 11/08/2024 at 10:00am.

Per conversation, Client did not get head and neck surgery. The follow up appointment on 11/08/2024 was to get the staples removed.

Facility made all appropriate notifications per regulation.

Exit interview conducted. Copy of report and LIC811 (Confidential Names) discussed and provided to Program Manager.