Facility Evaluation Report

Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to conduct a Health and Safety case management visit. This case management visit is in response to an unusual incident/injury report (UIR) that was received by this agency from the facility on June 28, 2022. LPA met with Administrator Pebbles Nakielski and explained the purpose of the visit.

The UIR documents that on June 26, 2022, client # 1 (C1) attempted to absent without leave (AWOL) and staff # 1 told C1 to go back to her room. The UIR documents C1 became increasing aggressive with S1 by snatching a book from S1 hand, hitting and kicking S1, throwing a book out the door, and shoving S1 out the door. The UIR further documents S1 called 911, officers were dispatched to the facility, and C1 was arrested for battery.

LPA reviewed the statements provided by staff regarding the incident, interviewed the administrator, and reviewed C1’s Individual Program Plan (IPP) and Positive Support Plans (PSP). LPAs obtained a copy of the IPP and PSP for C1. .

There are no health and safety concerns observed during this visit. Additional information will be required prior to closure inquiry into this incident.

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