Facility Evaluation Report

At approximately 12:50 PM, Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, Kristine Soriano. The purpose of the visit was to follow up on a self-reported incident that was submitted to Community Care Licensing (CCL).

LPA Nakagawa received a report on 12/15/2025 reporting an incident that occurred on 12/12/2025. Facility also self-reported the incident to Adult Protective Services. The incident report states that on 12/12/2025, Resident (R1) was being assisted in rest room by staff (S1). R1 stated that S1 sprayed them with room freshener rather than the hygienic skin cleanser while helping them. S1 stated that they were using hygienic skin cleanser, which was stored in close proximity to the air freshener and stated that R1 did not react to contact with the spray and it was only after being cleaned told S1 that the wrong product was used. According to Administrator, when investigating the incident they observed that both sprays were located beside one another in the bathroom.

R1 also stated that S1 caused marks to R1's arms while S1 was trying to prevent a fall. Resident Care Coordinator and Administrator checked R1 for skin tears and bruising and found no recent marks. R1's Physician's Report states that R1 has areas of thin skin and skin breakdown. Due to the reported incident and fall R1 was put on frequent checks for safety and fall prevention for 72 hours.

LPA found no evidence to corroborate that abuse or neglect occurred. Administrator stated that staff will be trained to communicate with the residents when carrying out their duties.

No deficiencies were found at the time of inspection. No citations issued.

Exit interview conducted with Administrator and a copy of this report along with LIC811 (Confidential Names) was provided .