Facility Evaluation Report

Licensing Program Analyst (LPA) Becky Mann 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 April 14, 2025. LPA met with Jonetta Williams, Assistant Administrator and explained the purpose of the visit.

The SIR documented that on March 31,2025, Client #1 (C1) was pushed into the fridge by Staff #1 (S1). Assistant Administrator spoke to S1 and stated that C1 raise their hand to S1 and S1 put their hand up to prevent C1 from hitting S1. During the event C1 was not injured. Assistant Administrator reported incident to CCL on 04/14/25.

During today's visit, LPA discuss the incident and surrounding events with Jonetta, Assistant Administrator. LPA interviewed staff, clients and reviewed records. During interviews, there was no enough evidence to corroborate the incident. S1 has been placed on administrative leave on 04/14/25. Internal facility investigation is still pending and a decision is being determined for S1 employment status with the facility.

Deficiency was issued during this visit due to the facility not submitting Special Incident Report (SIR) within 7 days of the incident which occurred at the facility. An exit interview was conducted where this report LIC809, LIC809D and appeal rights were reviewed, discussed and then provided to Jonetta Williams, Assistant Administrator.