Facility Evaluation Report

On 06/13/2023 at 12:00PM, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a case management visit. LPA met with Facility Designated Administrator, Katelyn Ledesma and explained the purpose of the visit. The purpose of the visit was to follow up on an facility reported incident that was received by the department on 05/25/2023. A brief interview with FDA Ledesma was conducted. Current census was 120.

The incident reported stated that on 04/27/2023, the Facility Designated Administrator was notified that they witnessed S1 smack a resident on the arm during NOC shift. On 04/28/2023, the FDA was notified by management that they received a phone call that staff witnessed S1 smack a resident during NOC shift between 04/25/2023-04/26/2023 which confirmed the notice that was received the previous day. An investigation was conducted by the facility and S1 was removed from the staffing schedule pending investigation. The investigation conducted by the facility confirmed that S1 smacked R1 while in care. An interview with S2 was conducted and it was learned that they were shadowing S1 during NOC shift. During evening rounds, R1 was exhibiting behaviors and hit S1. S2 witnessed S1 smack R1 back. S1 was terminated from the facility on 05/15/2023.

LPA obtained a copy of S1's personnel file and facility reports. Based on facility records and interview, staff is trained on personal rights of the residents during orientation.

Based on interview and records review there were the following deficiencies were observed and cited on the LIC 809-D pursuant to the California Code of Regulations, Title 22, and California Health and Safety Code.

Exit interview was conducted, a copy of the LIC809, LIC809-D and appeals rights were emailed the facility at the end of this visit. A electronic email response serves as receipt.