Facility Evaluation Report

Licensing Program Analyst (LPA) Olson conducted an unannounced Case Management- Incident visit to the facility above. LPA was accompanied by Tri-Counties Regional Center Quality Assurance Specialist (QAS) Miguel Magana. LPA and QAS met with Administrator and explained the purpose of the visit.

CCL received an incident report on 05/01/23 stating that on 05/01/23 Client 1 (C1) showed staff a bruise on their left side/lower back area that was around 6 inches long and that it hurt. LPA and QAS interviewed staff who stated when they asked what happened at first C1 said nothing, they didn’t fall or know how they got the bruise. A day or two days later C1 stated Staff 1 (S1) hit them. C1 also said another staff’s name and a client’s name but it wasn’t clear how they were involved. Staff stated C1 has limited vocabulary so it’s hard to know exactly what happened. LPA and QAS interviewed staff about the bruise. Some staff stated C1 sits down really fast and might have gotten the bruise from their armchair. Other staff says C1 sits down normal and isn’t sure how they got the bruise. A few staff stated that some Clients have said they don’t like S1. Staff mentioned that S1 is loud and yells in loud voice and tells clients to “get out”, “go there”, “go pee”. Administrator stated they’ve talked to S1 about this and to lower their voice and it gets better but then S1 goes back to using a loud voice. Administrator put S1 on leave while they investigated the incident.

Interview with Clients revealed clients are scared of S1 think their mean and they yell all the time. A client stated S1 says a bad word to and around clients. Client also stated S1 takes their stuff, throws away their print outs and broke their clock radio. Clients also stated S1 doesn’t allow them to sit on the staff couch. Client 1 stated "I got hit" LPA asked with what? "fist" "one time". When? Monday (S1) hit me.

LPA and QAS interviewed Staff 1 (S1) who stated they love all the clients and would never hit or hurt anyone. Staff admitted to having a loud voice and telling C1 to get out of the kitchen and go back to the living room for their safety while cooking. Staff said they can work on their voice and lower it and wants to go back to work.

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