Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility today in conjunction with a complaint investigation. LPA were greeted by caregiver and was granted entry. LPA met with Mitzi Avena and explained the nature of the visit.

This visit is to issue a citation for violation observed during the investigation of complaint number 22-AS-20240306093154. Interviews conducted with facility staff indicated that resident (R1) in November 2023 became more agitated, bullied staff and other residents, punched staff and resident and complained of pain even when they did not have pain. LPA did not find any LIC624 incident submitted by the facility for the changes that were observed.

Based on the information obtained there is a deficiency issued and are noted on the attached LIC809-D form.

This report is being reviewed with facility representative and a copy of this LIC809, LIC809-C and LIC809-D was provided and left at facility. Appeals Rights reviewed and a copy left at facility.