Facility Evaluation Report

On 03/17/2023 at 12:00 pm, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a Case Management visit. LPA Pascua was greeted by Facility Designated Administrator, Mai Xiong and explained the purpose of the visit. The current census was 3. 2 out of 3 residents were out at their respective day program at this time.

The purpose of this visit is to follow up on an incident report that was received by the department on, 02/13/2023. The incident reported that R1 had tried to self harm themselves through taking the shower cord and wrapping it around their neck. It was also reported that 911 was called as requested by the resident and was then taken to the hospital.

LPA reviewed R1's Physician report, Need's and Appriasals, and his Behavioral reports. It was learned through these reports that the resident has a history of suicidal ideations and self injurious behavior but has never attempted to physically hurt themself. LPA also conducted an interview with facility staff and it was stated that they did know about the the extent of the residents self injurious behavior but have been in contact with East Bay Regional Center and Behavioral Health to help mitigate the resident's behavior. It was learned that the facility has had a difficult time in getting response by East Bay Regional Center.

Based on interviews and records review, Based on interview and records review there were no deficiencies that were cited during this case management visit. LPA Pascua will come at a later time if further follow up is needed.

A copy of this report was provided to the facility and an exit interview was conducted.