Incident investigation·November 1, 2021

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA), Kathrina Chin to follow up on an incident reported to Community Care Licensing. LPA met with Executive Director(ED), Stephen Pratt and explained the purpose of today’s visit. Incident was self reported on 10/19/2021 regarding resident 1 (R1’s) incident on 10/18/2021. It was reported that resident went to her primary care physician on 10/18/2021 and her physician called and stated that resident presented with vaginal bleeding. Her physician indicated that "from the results of the examination, we are concerned and have reason to believe that there was elder abuse." Adult Protective Services was notified by the primary physician's office. The responsible party was informed by APS to immediately remove the resident from the property until a full investigation is completed. Resident moved out of the facility on 10/18/2021. Mr. Pratt stated that resident 1 moved into the facility on 9/2/2021. During the visit LPA obtained copies of the following documents pertaining to resident 1 (R1): 1) Information register 2) durable power of attorney 3) Physician's report and medication list 4) mini mental exam 5) pre-admission appraisal and assessment forms 6) care plan 7) Police Officer contact information 8) Memory Care list of employees who worked with resident 1 9) Resident 1's visitor log 10) SOC 341 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. An exit interview was conducted, and a copy of the report was given to Stephen Pratt, ED.