Incident investigation·September 27, 2024

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Case Management visit. LPA met with Executive Director Kimberly Garcia, and discussed the purpose of the visit. Today's visit is in response to a self reported incident from the facility dated 9/20/2024. On 9/23/2024, CCLD received an SOC341 regarding Resident 1 (R1). The date of incident was 9/19/24, regarding alleged personal rights violation. On today's date, LPA conducted interviews and reviewed facility records. According to SOC341, R1 reported to Staff 2 (S2) that on the night of 9/19/2024, Staff 1 (S1) refused to assist resident in requesting medication for pain. Interview with R1 corroborated that S1 refused to assist and proceeded to take away R1's call button while using inappropriate language towards R1. Interview with multiple outside sources revealed that there have been previous instance of S1 being rude with other residents and taking R1's cellular phone away. Outside source confirmed that prior instances had been reported to previous Executive Director. Based on R1's Physician Report, R1 is diagnosed with a major neurocognitive disorder but is capable of communicating need and does not have any inappropriate or aggressive behaviors. Interview with current Executive Director revealed that S1 has since been separated from facility. At this time a preponderance of evidence exists to show S1 violated R1's personal rights. A deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages). An exit interview was conducted with Executive Director, to whom a copy of this report, the LIC 809-D pages, the LIC811 Confidential Names List pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to.