Incident investigation·September 17, 2021

Licensing Program Analyst (LPA) Hansen conducted an unannounced case management inspection. LPA arrived to the facility and met with Administrator Brittany Karlinski. The purpose of this case management inspection is to follow up on a self reported incident report submitted to Community Care Licensing (CCL) on 9/1/2021. CCL received an incident report, submitted on 9/1/2021 Staff (S1) alleged Resident (R1) being pushed by (S2). Incident Report submitted to community Care Licensing (CCL) on 09/02/2021 reported the following: During a painting activity, R1 had paint on their face and S2 attempted to clean the paint off of R1's face. Upon further investigation it was determined R1 became agitated by S2 attempting to clean the paint from R1's face and R1 pushed S2. Administrator stated they conducted an internal investigation and will provide training on reporting requirements to staff. LPA conducted interviews and gathered information No deficiencies were issued during today's inspection Exit interview conducted with Brittany Karlinski Administrator