Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to deliver the results of a complaint investigation. During the complaint investigation, a case management deficiencies visit was conducted due to violations discovered during the investigation process. LPA met with Administrative Assistant Ernie Manaois.

While investigating the complaint dated February 4, 2022, LPA reviewed R1’s Appraisal Needs and Services Plan (ANS), dated December 15, 2021. R1’s ANS’s Socialization/Emotional sections are empty. R1's ANS form is also not signed. Based on a review of R1’s Physician’s Report, dated December 8, 2020, R1 has a mental disorder. R1’s physician report also states R1 does exhibit inappropriate behavior.

LPA reviewed R2’s Needs and Services Plan, dated October 24, 2021 R2’s ANS’s socialization and emotional section is empty. Based on a review of R2’s Physician’s Report, dated February 23, 2021, R2 has a mental disorder. The form also states R2 has aggressive behavior and is depressed.

Based on interviews conducted Staff S1 confirmed that the incident where R1 shoved R2 occurred in January 2022. S1 stated he/she witnessed R1 shove R2 and he/she intervened. S1 stated he/she then separated the residents. LPA requested the incident report, AA stated the facility did not send an incident report for this interaction with R1 and R2.

Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Administrative Assistant Ernie Manaois and a copy of the report and appeal rights were provided.