Facility Evaluation Report

LPA Jeung met with business services manager and memory care coordinator in response to Report of Suspected Abuse dated 5/22/23 regarding client #1 and private companion, and submitted to CCLD.

LPA was advised that private companion was removed from facility on 5/23/23. Based on wishes of family, private companion was allowed to resume companionship to client as of 5/31/23. It is unknown what, if any, additional training was provided to private companion by caregiver agency.

LPA reviewed file for client #1. In the admission agreement, pages 57, 58, 59 pertain to third party caregivers--Acknowledgement and Indemnification, Rules of Conduct for Third Party Caregivers--but the acknowledgement was not signed by the private companion, nor can it be confirmed that these documents were given to or acknowledged by private companion of client #1. This person also does not have criminal record clearance and association to facility.

LPA recommended that private attendants be required to acknowledge and sign Personal Rights forms LIC613C/LIC613C2 when providing services to facility clients.

Deficiency of the California Code of Regulations, Title 22 is cited on a following page.