Incident investigation·September 23, 2022

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 9/23/22 at 9:30a to obtain information regarding an incident report submitted to Community Care Licensing (CCL) regarding Resident #1 (R1). LPA met with Regina Farinias, Marketing Director and stated the purpose of the visit. The incident report indicated that the police arrived to obtain information for resident #1 (R1) as R1 was in a car accident on or about 9/15/22. LPA requested and obtained a copy of R1's Identification and Emergency Information (LIC601) dated 2/4/22, Physician report(s) (LIC602A) dated 1/20/22, 4/15/22, 4/27/22, Preplacement Appraisal (LIC 603) dated 2/4/22, Drivers License, and Out patient medications list. LPA conducted interviews of staff #1 (S1-S3) and R1 during this visit. A review of documentation provided revealed that R1's physician reports all indicate that R1 is able to leave facility unassisted with supervision. It also indicates that R1 is diagnosed with Mild Cognitive Impairment (MCI). The Preplacement Appraisal indicates resident can be a bit confused at times. The investigation revealed that R1 was driving alone and had an accident with no major injuries. Although R1 continued to drive a personal vehicle, the LIC602 indicates that R1 needed supervision. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Staff was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of the report was given.