Facility Evaluation Report

Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced Case Management - Incident visit. LPA identified herself, was granted entry into the facility, and met with Cherifer Manipon, Program Director, to whom LPA disclosed the purpose of the visit.

Today's visit was initiated in response to an SOC341 Report of Suspected Dependent Adult/Elder Abuse , which was received on 5/31/2024, in which licensee self-reported that Staff 1 (S1) [LIC 811 Confidential Names List was provided to identify the client and staff] pulled Client 1’s (C1) hair. Licensee promptly conducted an internal investigation, the results of which were quickly provided to Community Care Licensing. Interviews conducted and video surveillance revealed that, on the morning of 5/30/2024, C1 pulled S1’s hair, and S1 immediately responded by extending his/her arm and briefly pulling C1’s hair.

A Special Incident Report was also received on 6/5/2024, in which it was self-reported that, while unloading groceries from a vehicle, a staff who was serving as C1’s 1:1 staff, was summoned to assist with an incident occurring with another client. Upon returning to C1, Pine-Sol cleaner was left on a table in C1’s presence. While C1’s 1:1 staff was obtaining a snack for C1, C1 grabbed the bottle of Pine-Sol and placed it to his/her lips. C1’s 1:1 staff was able to obtain the bottle from C1 before C1 had an opportunity to ingest the liquid; however, C1 was able to place the cleaner to his/her lips. Poison control was contacted and medical advice/attention was sought. C1 was monitored for the remainder of the day and, reportedly, C1 did not exhibit adverse effects.

During today’s visit, LPA performed a brief facility tour and welfare check, observing clients who were present during the visit. No safety concerns were noted.

Based on evidence provided, deficiencies are being cited Per Title 22, Division 6, Chapter 8 of the California Code of Regulations in response to both of the above identified incidents and are listed on an LIC 809-D.