Incident investigation·May 31, 2024

Licensing Program Analyst (LPA) Tena Herrera made an unannounced Case Management visit to the facility. LPA met with Administrator Brandie Mendibles and explained the reason for the visit. The purpose of the visit is to conduct a Health and Safety Check in regards to a Special Incident Report (SIR) that was received on 5/21/24, regarding an incident in which S1 left R1 unattended while assisting with showering, R1 had an unwitnessed fall and suffered injuries during the time they were left unattended, which resulted in R1 being sent to the hospital and receiving staples on a laceration on their head. During todays visit LPA obtained copies of the following from Resident #1 (R1) file: Physician Reports (2024/2023), most current appraisal needs and service plan and hospital paperwork/discharge paperwork from this incident that was dated 5/18/2024. After interviews with both Administrator and S1 it was confirmed that the above incident did occur, after file review it was revealed that R1 needs max assistance with 1 person while showering. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during todays visit is documented on the 809D. Exit interview held and a copy of the report along with appeal rights were provided to Brandie Mendibles.