Facility Evaluation Report
On 5/9/2024, Licensing Program Analyst, Tobola arrived unannounced and was greeted by LVN Manager, Heidi Noriesta. The purpose of the visit is to follow up on several incident reports and facility initiated report of suspected abuse involving client (C1). Incident reports indicate reoccurrences of escalated actions of client C1 involving C1 causing property damage, self injurious behaviors, elopement and potentially putting other clients' personal rights at risk.
Facility implemented protocol to ensure staff provide additional supervision for C2 protecting their personal rights. Protocol includes redirecting C2 to their bedroom or closing C2's bedroom door with staff preventing C1 from engaging with C2 during incidents. LPA was informed that C2 is currently in the process of transitioning to a new facility with potential transfer dates.
LPA informed that continuous room checks and a 24/7 line of sight have been implemented for supervising C1. Medication updates and additional electronic devices have been implemented for C1 to help with keeping C1 at baseline potentially alleviate the amount of incidents. LPA and LVN Manager discussed and incident on 4/8/2024 in which C1 was supervised by staff (S1) resulting in C1 leaving line of sight. C1 had not been located for approximately one and a half hours. The property has a large plot of land towards the facility road entrance where C1 had been located. However, facility failed to ensure appropriate supervision. Facility immediately took administrative action to correct the incident. Management will be holding a meeting to further discuss C1's placement and health & safety admitted to the facility.
Lastly, LPA and LVN Manager discussed previous alleged incident involving staff (S2) and gathered facility and client documents.
Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction