Senior Care Records.

Facility Evaluation Report

Mission Home CBN INC, Elk Grove10/26/2021Licence 342700677

Capacity4
Census4
Date signed10/26/2021 02:52:50 PM
The inspector’s account

Licensing Program Analyst (LPA) C. Valerio arrived at the facility unannounced to conduct a case management visit. LPA Valerio was screened for COVID-19 symptoms prior to being allowed entry into the facility. Facility staff confirmed zero residents and staff have displayed any signs or symptoms of COVID-19 in the last 10 days. LPA Valerio met with facility staff Orlando Carpio.

LPA Valerio reviewed incident reports disclosing that resident 1 (R1) physically punched two residents (R2 and R3) in the face while residing at Mission Home Care CBN, Inc. R2 and R3 are non-verbal and could not verbalize if they were in pain. R2 had a swollen face after R2 was punched by R1. R3 was not observed to have any injuries after being punched.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, a deficiency is being cited and can be found on LIC 809-D. Exit interview was held and a copy of report was left at the facility.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction