Incident investigation·November 16, 2023

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit to the facility for the purpose to address a Special Incident Report (SIR) with occurrence date of 10/8/2023 received in Community Care Licensing Orange County Regional Office on 11/9/2023. LPA Quiroz was greeted and granted entry by Caregiver Tuyet Nguyen. LPA Quiroz called and spoke to Licensee/Administrator Mai Nguyen and discussed purpose of today's visit. (L/AD) Mai Nguyen arrived on or about 10:58am. On or about 11:03am, LPA Quiroz along with (L/AD) Mai Nguyen toured the interior and exterior of the facility premises. Documentation review of SIR dated 10/8/2023 indicates alleged mistreatment to Resident (1) from Caregiver 1 (CG1) and Caregiver 2 (CG2). L/AD Nguyen indicated "Staff no longer work at the facility. (R1) was relocated to another facility. I don't know where the caregivers are working now." LPA Quiroz provided consultation of California Code of Regulation (CCR) 87211 - Reporting Requirements(a)(1)(D) .(a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.(D)Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. Facility cited during today's visit under California Code of Regulation (CCR) 87211 - Reporting Requirements(a)(1)(D) . An exit interview was conducted with (L/AD) Mai Nguyen, and a copy of this report, LIC 809-D, Appeal Rights and LIC 811-Confidential Names were provided at exit.