Incident investigation·June 9, 2021

*Amended* While conducting annual required inspection Licensing Program Analyst(LPA) Leslie Ibo conducted a Case Management with Administrator Jaime Ruiz and house manager Joyce Pelea, in relation to the incident report submitted on 6/8/2021, R1 had un-witnessed fall in the bathroom on 6/4/2021. During the interview S1 assisted R1 to the bathroom and stayed outside the bathroom to provide privacy, while other staff ( S2 ) was at the kitchen area. Based on R1’s assessment report, R1 needed toilet assistance and based on physician’s report R1 is non-ambulatory, confused with Dementia diagnosis. LPA interviewed Administrator, based on interview conducted R1 is fall risk and needed staff to assist R1 inside the toilet. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report was provided.