Facility Evaluation Report

Licensing Program Analyst (LPA) Olson conducted a Case Management - Incident visit to investigate an incident the facility self reported. LPA was accompanied by Vince Figueroa, Quality Assurance Specialist (QAS) for Tri-Counties Regional Center. LPA and QAS met with Ed Maldonado, Administrator and explained the purpose of the visit.

CCL received an incident report on 1/04/23 stating that on 1/03/23 staff noticed Client 1 (C1) had bruising on left inner part of their eye and when asked what happened C1 stated Staff 1 (S1) threw a water bottle at them on 1/1/23.

LPA and QAS toured the facility and interviewed Administrator, Staff and Clients regarding the incident. LPA and QAS requested relevant documents. At this time, further investigation is needed. LPA will follow up at a later date to continue the investigation.

Around 11:15 AM LPA and QAS observed one light bulb in the bathroom fixture with 2 light bulbs out.

Around 11:20 AM LPA and QAS observed Client 1's dresser to have a missing handle and their blinds to be dusty.

Around 1:15 PM LPA and QAS observed Client 2's dresser to have used Kleenex bunched up.

Around 1:30 PM LPA and QAS observed Client 3's bathtub to have soap buildup and a rag to be partially black. The sink was observed to have hair in it and around it.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D).

Exit interview conducted and a copy of the report emailed to the administrator/licensee.