Incident investigation·July 7, 2021

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Ruth Martinez to follow up on an incident reported to CCL. LPA arrived at facility was greeted by Joseph Sathers, Administrator and explained the purpose for today’s visit. Incident was self reported on 06/30/2021 regarding R1’s incident on 6/29/2021. During today’s visit, LPA took a tour of the facility incident site, interviewed administrator, interviewed staff, interviewed resident and obtained copies of pertinent documents. On 6/26/2021 two staff were changing R1 when R1 became combative with caregivers. When caregivers were close to finishing assisting R1, R1 kicked caregiver in the head. S1 (caregiver) attempted to push the leg away, but also slapped R1’s leg. Incident was reported to Administrator on 6/30/2021. Administrator immediately reported the incident to all required. Caregiver is no longer employed at facility and Administrator held a refresher training to all staff on care and supervision of residents as well as mandated reporter requirements. LPA found that facility acted in a timely manner to address the incident and all other immediate attention to incident in question. LPA did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations . This report was reviewed with Joseph Sathers, Administrator and a copy of the LIC809 and LIC811 was provided and left at the facility.