Facility Evaluation Report
On 04/06/2023 at 9:18 a.m. Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced for a case management visit . This case management visit is in response to a special incident report (SIR) that this agency received from the facility on March 22, 2023. LPA met with caregiver Shanellrreya Knowles and explained the purpose of the visit.
The SIR documented that on March 20, 2023, resident # 1 (R1) was agitated with staff # 1 (S1), which resulted in R1 assaulting S1. The SIR further documented that S1 threatened R1 in response to being assaulted.
Inquiry into this incident included conducting a facility tour to assess for any Health and Safety concerns. LPA was unable to interview R1 because they were at school. On March 23, 2023, LPA conducted a telephone interview with the administrator about this incident.
LPA advised Knowles that, at this time, this incident requires further investigation. Possible follow-up telephone calls, requests for copies of relevant documents, and visits are necessary before reaching investigative findings.
No deficiencies were cited during this visit. An exit interview was conducted where this report (LIC 809) was discussed and provided to Knowles.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction