Incident investigation·August 3, 2022

Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management visit to follow up on a incident report, received by Community Care Licensing on 7/26/22. LPA was greeted and granted entry into the facility by Caregiver Peter Chua. Leona Jardin, Administrator arrived at the facility shortly after LPA's arrival and the purpose of the visit was discussed. The facility self reported an incident regarding Resident 1 (R1) that occurred on 7/21/22. R1 reported to Licensee that Staff 1 (S1) and Staff 2 (S2) are being aggressive and abusive when assisting Resident 2 (R2). Licensee notified the responsible party for R2 and all appropriate agencies. During today's visit, LPA toured the facility, completed a health and safety check of residents, reviewed records, and interviewed staff and residents. No deficiencies were issued during today's visit. An exit interview was conducted with Leona Jardin, Administrator, to whom a copy of this report, LIC 811 Confidential Names and the Licensee/Appeal Rights (LIC9058 01/16) were provided to the Administrator.