Facility Evaluation Report

On 12-4-2025 at 1:29pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding facility reported incidents on 11-6-2025 and 11-7-2025. LPA met with program director (PD) Jerry Poole and explained the purpose of the visit. LPA reviewed incident reports with PD as well as additional facility file documentation including individual program plans (IPPs) for resident1 (R1) and R2, as well as individual service plan (ISP) for R2.

Incident #1: On 11-6-2025 it was reported that on 11-5-2025 at 2:26pm, it was reported that R1 became upset after a staff member asked R1 to move over while walking in a store. R1 then became upset, removed his glasses, then broke them. At approximately 2:29pm, it was reported that R1 informed a family member that a staff member hit him in the chest as well as telling him to move. No injuries reported. Incident was reported by facility to licensing department, ombudsman, and police within regulatory time frames. At approximately 6:39pm, police department notified facility that surveillance footage from the store was reviewed, and revealed that a peer struck R1 and not a staff member. Facility staff followed up with R1's responsible party and conducted an interdisciplinary team meeting (IDT) on 11-20-2025 to address R1's behaviors. Additional interventions are in place for supervision of R1 including virtual participation with plans to return to program after a re-evaluation per responsible party's wishes. R1's IPP is updated to reflect R1's on-going behaviors and interventions.

Incident #2: On 11-7-2025, it was reported that on 11-7-2025, while in a classroom, R2 exhibited aggressive behavior towards facility staff. Facility staff accompanied R2 outside for de-escalation. As R2 passed by one of R2's peers, R2 struck the peer on the right shoulder with an open hand. The peer responded and grabbed R2 on the upper collar of R2's shirt, and hitting and scratching the right side of R2's face and shoulder with an open hand. Facility staff was successful at separating both residents timely. R2 was transported to urgent care for evaluation and treatment for minor injuries due to laceration. {Cont. on 809C}