Facility Evaluation Report

On 12/7/23, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced case management visit regarding an incident report. LPA met with Program Director, Ryan Mock & Administrator, Matthew Canon. LPA explained the purpose of today's visit.

On 11/ 28/23 Licensing received a report regarding a staff (S1) put a hot glue gun on a residents (R1) neck.

Based on interview with a witness (S2), there was an activity in the main room where some residents are doing a project. S2 had to go and open a door to let a group in who just came from an outing. When S2 turned around to go back to the activity area, he/she saw S1 put a hot glue gun on R1. S2 asked S1 on what they are doing and R1 stood up and walked away. S2 went to check on R1 and saw a red mark on the neck.

Facility investigated the incident and S1 was let go from his/her work.

Deficiency is being cited today as the facility did not ensure that the resident's personal rights is not violated.

Deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties.

Report was discussed and a copy of the report & appeals rights is provided.