Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon conducted a Case Management - Incident to the facility above. LPA met with Administrator Joni Chapman and explained the purpose of the visit.

LPA De Leon received a self reported incident report from the facility regarding a resident. LPA De Leon received a copy of video footage showing an incident occurring between staff 1 (S1) and resident 1 (R1) at the facility. The video footage did not have sound. The footage showed S1 using a chair prodding at R1 to keep R1 from coming into the kitchen and getting in the drawer, the staff was grabbing at or near R1 and R1 was being pulled across the floor. The video did not show all the angles of the footage. The facility has video footage in the common areas of the home and due to a staff not clocking out on a shift the Fiance Manager watched video footage on 12/20/2023 to verify the time the staff left the facility for payroll hours worked purposes. The Finance Manager immediately notified the Executive Director of C.A.L.L the video footage showed an incident with S1 and R1. S1 was immediately put on suspension on 12/20/2023 and S1 was terminated by the facility on 12/21/2023. R1 did not have any noticeable injuries from the incident.

LPA requested the following records from the facility: R1's LIC. 602 Physicians Report, Appraisal needs and services plan, TCRC's IPP /or ISP, Staff notes and/or charting for R1 from 12/01/2023-12/31/2023, S1 personnel file with a copy of any and all disciplinary records for any facility S1 worked at during S1's employment with the C.A.L.L. programs and facilities, The name of the staff that came on shift on 12/04/2023 at 7:00am and the name of the staff that comes on shift and is shown in the video footage.

Exit interview conducted, deficiency cited, copy of report and appeal rights printed for Administrator.