Facility Evaluation Report

On 5/8/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced to the facility to conduct a case management visit regarding a Special Incident report received on 5/3/2023 stating Resident #1 (R1) was stabbed in the head while outside the home. LPA met with Caregiver, Kathy Davis who was informed of the purpose of the visit.

LPA toured the facility inside and out with Kathy Davis, interviewed staff and reviewed resident file. LPA was informed R1 was taken to the hospital for medical assistance and has since been back at the home.

During interview with staff, LPA was informed that R1 is independent and goes out to the community without supervision. LPA reviewed R1’s file, file review revealed no documentation that shows R1 is independent, no documentation showing an appraisal was performed prior to R1’s admission into the facility, no medical assessment documentation, no Needs and Services Plan developed for R1. Facility also failed to report to the department each time R1 left the facility unsupervised.

Therefore, based on the observations made during today’s visit, two #2 citations will be issued per Title 22, Division 6 of the California Code of Regulations. See LIC 809D. An exit interview was conducted, and this reported was provided along with appeal rights to Kathy Davis.