Facility Evaluation Report

Licensing Program Analyst (LPA) Teresa Camara conducted a case management - incident visit regarding a self-reported incident which occurred at the facility on or about 9/29/2024. LPA met with administrator Roman Tovar and assistant administrator Leticia Hernandez and explained the reason for the visit. LPA was joined by Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Katy Robison.

LPA and QAS first met with the assistant administrator and requested pertinent documents. LPA and QAS conducted interviews with staff and resident 1 (R1) starting at 1:42 p.m. There were more staff LPA and QAS needed to interview but they were not at the facility. LPA will return at a later date to complete the investigation.

It had been reported that on 9/29/2024, R1 reported to staff they were handled roughly by staff 1 (S1). This was reported to Community Care Licensing (CCL) on 10/9/2024. The facility conducted their own internal investigation and shared the information they obtained.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC809-D).

Exit interview conducted. Copy of report and appeal rights issued.