Facility Evaluation Report

Licensing Program Analyst (LPA) Kesha Lewis and Albert Johnson conducted an unannounced case management visit to the facility on 10/03/2022 to follow up on an incident that occurred on 9/18/22.

LPA reviewed special incident report stating R1 had attacked staff and another resident. R1 had . R1 had been bitten on the arm by R2 , staff had water thrown at them and their hair pulled and R2 hit S1 several times.

During today's visit, LPA reviewed R2 file. The facility is providing respite care for R2. They have patch funding. R2 came from a negotiated rate home. The facility is trying to get R2 moved because he is not a good fit with other residents in care.

LPA requested updated copies via email to LPA by October 17th, 2022 Emergency Disaster Plan/Infection control Monkey pox. Kesha.Lewis@dss.ca.gov