Facility Evaluation Report

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent unannounced Case Management - Incident visit at approx 11:00 a.m. to continue the investigation of a self-reported incident that was initially conducted on 09/05/2024 between 12:30 p.m. - 02:30 p.m. Upon arrival LPA met with Executive Director Lilit Mnatsakanyan and explained the reason for the visit.

At approx 11:15 a.m. LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of additional pertinent documentation relevant to the investigation.

On 08/23/2024, the Department received an incident reports stating on 08/15/2024 at approx 8am, Staff #1 (S1) was observed to be handling Resident #1(R1) in a firm manner while R1 attempted to swing their arms in an agitated manner, resulting in discoloration / bruising on R1's forearms. R1 did not indicate any discomfort or additional injuries.

Interviews conducted with staff and Executive Director revealed on 08/15/2024 at approx 8:00 a.m. Staff #2 (S2) attempted to change R1's clothes for breakfast. R1 reacted with increased agitation and became combative towards S2. S1 entered the room to provide assistance to S2. R1's agitation and combative behavior escalated towards both staff members. S1 then restrained R1 by grasping both wrists, which led to bruising on R1's forearms. LPA's records review indicated S1 was suspended pending an investigation, both law enforcement and R1's family were notified of the incident on the same day it occurred. Additionally, S1 voluntarily resigned from their position following the incident. Based on the investigation's findings, there is sufficient evidence to conclude that S1 handled R1 in a rough manner , resulting in bruising on R1's forearms.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to 809-D).

Exit interview conducted. Copy of report and appeal rights were reviewed and issued during today's visit.