Facility Evaluation Report

Licensing Program Analyst (LPA) Williams arrived on Monday November 24, 2021 to conduct a health & safety check regarding an incident that occurred on November 17, 2021. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA was screened by staff prior to entry.

LPA spoke with staff Yurell Huntsberry and requested the following documents: hospital discharge paperwork, wound care paperwork, and updated staffing schedule for 1-on-1's with R1. LPA spoke with Administrator Howard Huntsberry via telephone and asked how R1's behavior has been since being discharged from the hospital yesterday. Administrator stated his behavior has been fine since he has returned. Administrator stated that R1's behavior in the hospital was agitated, but when R1 returned to the facility yesterday, he apologized for his behavior at the hospital. Administrator stated R1 showed that he is capable of changing the wound dressing himself and did it today. Administrator stated R1 has his first appointment at the hospital on 12/02/2021 at 9:30AM at Sutter Roseville.

LPA asked if R1 was in the facility, staff informed LPA that R1's mother took him shopping about 20-30 minutes ago and is unsure when R1 will return. LPA waited outside for 15 minutes until R1 arrived with his mother.

LPA entered facility with R1 and spoke to him in his bedroom. LPA and R1 discussed the three bandages covering his wounds. R1 stated he is capable of replacing them and does so daily. He stated it is painful but he knows he has to replace. R1 stated he applies alot of tape so the dressings don't come off during the day. R1 stated he sometimes wheezes from wounds and avoids sleeping on his right side because of pain in his lung. R1 apologized and stated he was feeling very sleepy, and suddenly fell asleep.

Exit interview conducted. Copy of report left at facility.