Facility Evaluation Report

On 11/25/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced case management visit to follow up on an incident that was reported to CCLD on 11/21/24. LPA met with Case Manager Edralyn JImenez and explained the purpose of the visit.

CCLD received report that at approximately 8:40am staff heard a client (C1) call out , "Help me, I tripped."

Staff (S1) approached C1 , who was positioned on the floor on his/her knees and elbows , and observed bleeding around the mouth . S2 approached and assisted S1 to position C1 in a seated position on the floor with back agains t the wall. Staff assessed SM's injuries and observed a contusion on the forehead. Staff administered first aid and called 911. After arriving at the hospital and C1 has been assessed, hospital staff determined that C1 suffered broken bones in the neck and that surgery was needed. Surgery has been scheduled.

As of this report, surgery was scheduled and successful.

According to S3, there was no staff who was able to assist C1 while entering the back of the building. The 2 other staff that was with C1 when picked up in the home facility were also assisting other clients leaving C1 to enter on his/her own. While C1 doesn't like being assisted, there should have been a staff at least looking at C1 in case C1 needs help.

On C1s admission agreement it states that "the basic services that you will receive from SVS include planned activities, continuous supervision and assistance with your personal needs including self-medication if necessary."

Based on interviews and records review, 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.

This report is reviewed and a copy of this report and the appeal rights were provided.