Complaint Investigation Report

At this point, R1 came into the kitchen from the living room and grabbed the knife, according to the SIR. Administrator Mercado corroborated this narrative during an interview.

R1’s IPP indicated that R1 has limited safety awareness, and that family members had previously expressed concerns regarding R1’s ability to handle knives safely.

During an interview, S1 said that on February 26, 2023, they set a knife down on the counter, and turned their back to R1 while R1 was in the living room in order to look for more fruit in the refrigerator.

The department has determined the following as it relates to the allegation that knives are accessible to resident in care:

Based on record review of R1's IPP and SIRs, and based on interviews with administrator Mercado and S1, a knife was accessible to a resident on February 26, 2023, and, therefore, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met. This facility is being cited per 22 CCR Section 80087(g).

An exit interview was held with Mercado. A copy of this report and appeal rights were left with Mercado.