Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Case Management – Incident visit for the purpose of a subsequent visit following up on a self-reported incident report received in the Woodland Hills Regional Office on 05/04/2022. LPA met with Administrator Robert Gutierrez and explained the reason for today's visit. Entrance interview conducted.

The written incident report contained information regarding an incident involving Resident #1 (R1) and Resident #2 (R2) that occurred in R2's room on 05/04/2022. During today's visit at 12:25PM, LPA, along with Administrator, reviewed the camera footage for the date of the incident. LPA interviewed Administrator throughout the visit, and LPA and Administrator toured the Memory Care at 12:58PM.

No immediate health and safety concerns were observed during today's visit.

LPA has determined further investigation is needed. The LPA will return at a later date to continue the investigation.

Exit interview conducted. A copy of the report was provided via email.