Facility Evaluation Report

This unannounced case management visit is conducted by Licensing Program Analyst (LPA), Kathrina Chin to follow up on an incident on Self Injurious Behavior(SIB) and suicidal thoughts was reported to Community Care Licensing on 11/15/2021. LPA arrived at facility and met with three caregivers, Alex Navarro, Helen Balbalang, and Marissa Aquino and spoke to Martin Lopez, Administrator.

Mr. Martin stated that resident 1 was admitted on July 2019 and left on January 2021 to move back with her mother. On June 8, 2021, resident was re-admitted to the facility. On November 14, 2021, resident 1 displayed self injurious behavior by punching herself and was suicidal. The CAT Team arrived that day on 11/14/2021 at 9:30 AM. Mr. Martin brought resident to Anaheim Global Medical Center and resident stated that she wanted to receive treatment at the hospital and a voluntary hold was done. Resident 1 was admitted to the hospital and remain at the hospital as of today. Mr. Martin stated that a 30 day notice was served to the resident on October 2021. Mr. Martin stated that he would like to request a 3 day eviction and he will send all the documents to the licensing office.

At this time, based on the information available, there are no deficiencies being cited per Title 22, Division 6 of the California Code of Regulations .

An exit interview interview was conducted and a copy of this report was provided to the facility.