Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Administrator (ADM) Evelyn Canonizado. The purpose of the visit was to investigate an incident that was reported by the facility via Unusual Incident/Injury Report stating that staff S1 was found to have tied the door knob of the hallway door to a couch at night.

During visit, LPA Marrufo interviewed Administrator Canonizado regarding the incident. ADM Canonizado stated that the incident occurred on 08/15/2022 when police arrived at the facility in response to another incident. The police arrived at around 11:30 PM and entered the side gate of the facility and came around to the rear door of the facility. The police knocked on the rear door and S1 answered the door. Upon entering the facility, the police observed the hallway door to be tied to a foot of the couch by the hallway. The police called ADM Canonizado and when ADM Canonizado arrived, the police showed her a photograph of the door as the police found it upon their arrival. ADM Canonizado states that the photograph showed the hallway door knob tied with two or three shoe strings tied together to one of the feet of the couch by the hallway. ADM stated that the police officers did not provide her with the photograph.

ADM Canonizado states that S1 was a live in staff and was relieved of duty immediately when ADM arrived. ADM stated that S1 has not worked at the facility since the incident. During visit, LPA Marrufo reviewed the staffing schedule and confirmed that S1 was no longer scheduled to work at the facility.

During visit, LPA Marrufo interviewed residents R1-R5 and attempted an interview with R6.

LPA Marrufo interviewed staff S1-S2. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D for more information. This report was reviewed with Administrator Evelyn Canonizado and a copy of the report was provided.