Facility Evaluation Report

At 11:57am on 10/17/2024, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to conduct a case management visit based on the Serious Incident Report (SIR) submitted on 10/17/2024 for incident that took place on 10/13/2024, and reported by phone to case carrying LPA on 10/14/2024. SIR summation of Client sustained serious injury, due to suspected abuse by staff. LPA Jeffries met with Administrator, Joni Chapman announced who he is and the reason for the visit.

Administrator explained to LPA Jeffries the events that took place in the facility on 10/13/2024 at approximately 6:00pm. LPA then observed and recorded the video of two angles of the incident. LPA Jeffries noted that the Administrator was advised to update SIR on events that have transpired as a result of the incident on 10/13/2024. LPA Jeffries advised Administrator to complete SOC-341 and notify local law enforcement of the suspected abuse of client by staff. Administrator stated that at this time they were "upset" by the video and stated that staff 1 (S1) "S1 did push the gate but I didn't know if S1 was pushing the gate to hurt Client 1(C1)?" LPA noted that Administrator stated that S1 was put on suspension and notified of termination on 10/15/2024. LPA Jeffries requested the following documentation:

-S1 all training records, all subsequent reports and any disciplinary reports or actions taken in last 12 months.

-C1 LIC602, Individual Personal Plan (IPP), Individual Service Plan (ISP), Release documentation from the hospital from injury that occurred from the incident, Local Law enforcement case number. Appraisals Needs and Assessment Plan

LPA noted that SOC-341 was completed at time of this case management visit and the San Luis Obispo County Sheriff was notified by phone during the visit. LPA concluded the visit and may return at a later date to follow up. Report read, and report provided.