Facility Evaluation Report

On 12/21/21, Licensing Program Analysts (LPAs) Anna Bueno and Bernadette Allen conducted an unannounced visit for the purpose of gathering details for an incident report provided to Community Care Licensing (CCL) by Doris Ekanem on 12/10/21.

On 12/10/21 at approximately 9 AM, Client 1 (C1) was being transported to the day program by Staff 1 (S1) on 12/10/21. Another vehicle caused S1 to brake quickly, which caused C1 to fall out of their wheelchair. C1 landed on their left shoulder/arm. C1 was not securely fastened in the wheelchair seatbelt. S1 phoned program director Ekanem and Ekanem and Staff 2 (S2) arrived at the scene of the accident. Ekanem, S1, and S2 assisted C1 back into their chair. Ekanem assessed C1 who did not appear to have any visible wounds, cuts, or abrasions. C1's responsible party (RP) was contacted and allowed C1 to return to day program. When S1 returned C1 to their home after progam, RP informed S1 that C1 was not right and RP will be taking C1 to the hospital.

On 12/11/21, RP contacted Ekanem to notify her that C1 had fractured their right hip in two places and their neck as a result of falling out of the wheelchair on 12/10/21. On 12/12/21, RP contacted Ekanem and provided an update on C1's injuries. C1 had fractured the right and left hip, with the right hip being broken in two places. C1 had hip surgery on 12/13/21 and was assessed for a neck surgery on 12/21/21. The facility conducted an internal investigation on 12/14/21 through 12/15/21 and S1 admitted that while they secured the wheelchair, they did not check whether C1's seatbelt was secured.

Based on LPAs observations and interviews, a citation will be issued during today's visit. California Code of Regulations, (Title 22, Division 6) is being cited on the attached LIC809D. An exit interview was conducted where this report, 809D, LIC 811 and appeal rights were provided to Mr. Jimenez.