Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - incident visit. LPA met with Administrator, Audrey Ann Salvador and Designated Administrator, Anelise Teodoro. The purpose of the visit was to follow-up on an incident report and SOC341 the Department received on 12/02/2024. It was reported that staff (S2) saw staff (S1) allegedly pull resident (R1)'s hair.

During visit, LPA interviewed 6 staff members. 2 out of 6 staff members were witnesses to the incident that occurred the night of 11/26/2024. Based on staff interview, S2 was only visiting the facility and was informed by staff (S3) that R1 was upset and was having a behavior. S2 walked to the living room area to assist with R1, when S2 observed R1 on the floor with S1 bending over and pulling R1's hair. 2 out of 2 staff observed S1 pull a portion of R1's hair. 2 out of 2 staff stated that S1 was not pulling R1's hair aggressively. It was stated that S1 seemed a little frustrated with R1 and blurted out a bad word. As soon as S2 walked into the living room, S1 immediately released R1's hair. Based on the incident report, a body check was performed on R1 and there were no marks observed. The incident was reported to R1's authorized representatives and other agencies.

Based on staff interview, the Administrator was informed of the incident on the same night of 11/26/2024. The Administrator conducted an internal investigation and informed the Licensee on 11/27/2024. S1 was suspended from work until further investigation. S1's last day of work at the facility was on 11/27/2024. Facility staff are scheduled for training on R1's behavioral plan on 12/04/2024. Licensee will also provide staff training on personal rights and proper direction on 12/04/2024. Licensee will submit the completed trainings to LPA Dolores by 12/05/2024.

Documents were obtained via email to include R1's physician's report, IPP, needs and services plan, emergency contact information, and behavioral plan. Documents were requested via email before end of day today: staff schedule for the week of 11/25/2024.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Anelise Teodoro and a copy of the report was provided.