Incident investigation·October 28, 2022

Licensing Program Analysts (LPAs) Kimberly Ramirez and Elizabeth Irra conducted a Case Management to obtain further information regarding a Special Incident involving R-1 and R-2 which occurred on 10/04/2022. LPAs met with Laura Hernandez and discussed the purpose of today's visit. The Special Incident alleges that R-3 witnessed R-1 grabbed R-2 on the breast. R-1 has mild cognitive impairment and R-2 has Dementia. R-3 no longer resides at this facility. During this visit, LPAs obtained a copy of the staff roster with contact information and a copy of the resident roster. At approximately 10 A.M., LPA reviewed resident files for Resident #1 through Resident #3 (R-1 through R-3) and obtained documentation. LPAs were unable to conduct interviews as there are (7) residents and (1) staff that tested COVID 19+ on 10/27/2022 (results were provided to Laura Hernandez today). Exit interview conducted and a copy of this report was provided to Laura Hernandez.