Incident investigation·March 7, 2022

Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Case management visit and met with administrator Darlene Romero. The purpose of today’s visit is to conduct a health and safety inspection and to gather information regarding the SIR/UIR (unusual incident report) dated 2/27/22, for an incident involving resident #1. According to the incident report, the smoke detector was going off in room 202 and smoke was coming from the room. Residents were evacuated and Fire and PD were called. Staff spoke to resident #1 who currently lives in room 202 and he stated he was given a lighter by his wife. Facility staff stated that they had informed the wife not to provide the resident with a lighted prior to the incident. There were no witnesses to the incident. During the visit LPA Baptiste interviewed administrator, reviewed resident #1 file and requested supportive documents (Resident departure form and face sheet). LPA toured resident #1 room and observed all of resident’s belongings gone and room in renovation due to fire. Resident #1 is no longer available for interview, wife moved resident out of the facility on 3/4/22. Based on the available information, there are no citations issued per California Code of Regulations under Title 22, Division 6, at this time. Visit concluded with exit interview, copy of report given to the Administrator.