Senior Care Records.

Facility Evaluation Report

11772 Justine Way, Adelanto08/14/2023Licence 361800222

Capacity4
Census4
Date signed08/14/2023 11:40:27 AM
The inspector’s account

Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to conduct a Health and Safety case management visit. This case management visit is in response to a special incident report (SIR) that was received by this agency on August 14, 2023. LPA Nickolas met with house manager Shanellreya Knowles and explained the purpose of the visit. This case management visit included a facility tour and interviews with relevant parties.

The SIR documents that on August 8, 2023, resident #1 (R1) foot was struck by a vehicle while crossing the street. LPA Nickolas' interview with staff #1 (S1) revealed that R1 was away without leave (AWOL); S1 followed R1 in the facility vehicle to ensure that R1 was safe. S1 stated that they turned on their hazard lights as R1 crossed the street, and an unknown individual driving a dark colored vehicle swerved around the company van and hit R1's foot. LPA Nickolas' interview with R1 revealed that R1 could not recall the incident. R1 showed LPA NIckolas a red mark behind their ankle and stated they received it from the car. R1 expressed no health or safety concerns about living at the facility.

No health and safety concerns were discovered, and the investigation into this incident is closed.

No deficiencies were cited during this visit. An exit interview was conducted where this report (LIC 809) was discussed and provided to the Knowles.

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