Facility Evaluation Report

On 2-17-22 at 2:25pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management regarding complaint # 27-AS-20220120131855. LPA met with Administrator Adetayo Kokumo and explained the purpose of the visit. During the complaint investigation, LPA reviewed incident report dated 12-26-21 and interviewed Resident1 (R1), R2, Staff1 (S1), and Administrator. Based on interview and record review it was determined that a physical encounter between R1 and R2 occurred on a date not recalled by R1 and R2 nor by S1 and Administrator, and was not reported to licensing department, ombudsman, or local law enforcement. Based on interviews with Administrator and S1, an injury to R1 was later discovered on 12-26-21.

Additionally, it was discovered during complaint visit that on 12-26-21, R1 was discovered to have sustained an injury and 9-1-1 was not called immediately to address the injury.

As a result of today’s visit, deficiencies are cited under Title 22, Division 6, Chapter 8. An exit interview was conducted with Adetayo Kokumo and a copy of this report was left with Adetayo. Appeal Rights provided .