Incident investigation·May 17, 2021

On 05/17/2021 around 11:00am Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced Case Management – Incident to conduct a Health & Safety check and follow-up on an incident reported to Community Care Licensing (CCL). During today’s visit LPA met with Clifford Johnson and the purpose of the visit was explained. On 5/14/21, CCL received an incident report regarding Resident #1. According to the incident report R1 jumped off a freeway overpass and is now deceased. During today’s visit LPA toured facility's physical Plant. The tour consisted of a 3--story building, all common areas which included but were not limited to; building entrances, reception areas, office, hallways, public restrooms, dining room, kitchen, pantry, medication storage and patio area. LPA also reviewed the facility's entry procedures, body temperature monitoring practices, social distancing practices, protective facial covering practices and disinfection/sanitation practices. LPA requested copies of the staff and resident rosters along with a copy of the following from Resident #1 facility's record by 5/19/2021. · Pre-Placement Appraisal’s · Admission Agreement · Identification and Emergency Information's · Reappraisals · Needs and Services Plans · Behavior assessments · Physicians Reports · Medication Logs · Incident Reports · Progress Notes · Hospital discharge notes · Death Certificate Due to insufficient information further investigation is needed. A telephonic exit interview was conducted with administrator and a hard copy was provided.