Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Stephanie Valera . The purpose of the visit was to conduct a wellness check and conduct interviews regarding an incident self-reported by the facility administrator. The incident involved allegations made by former staff that other staff had physically and emotionally abused residents. The incident occurred on 09/01/2021 and was reported to the Department that day.

During visit, LPA Marrufo conducted wellness checks and interviews with 5 out of 5 residents and 3 out of 3 staff. Resident R1 reported that a former staff asked R1 to lie on the floor when R1 was having an episode of damaging the facility property and the former staff put his/her hands on R1's shoulders. LPA Marrufo was not able to determine from the interview with R1 if R1 was hurt by the former staff in that incident.

LPA Marrufo reviewed the staff schedule and resident roster during visit as well as the following documents for residents R1-R3: Emergency Contact Form, Physician's Report, and Appraisal/Needs and Services Plan.

During visit, LPA conducted a telephone interview with R1's family member and made attempted telephone interviews with R2 and R2's family as well as with three former staff.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

An Advisory Note was issued. See LIC9102 for more information. This report was reviewed with Stephanie Valera and a copy of the report was provided.