Incident investigation·November 29, 2022

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to follow up on a recent incident that occurred at the facility. LPA met with Administrator, Val Paraiso who was informed of the purpose of the visit. The regional office received a police report from an incident that occurred at the facility on 11/02/2022 between Resident (R1) and Resident 2 (R2). The police report from the San Marcos station details that the administrator called the police after R1 struck R2 with a cane. LPA reviewed resident records for Resident 1 (R1) and Resident 2 (R2) and took statements from the administrator. R1 is no longer residing at the facility and was the former roommate of R2. On 10/27/2022 R1 struck R2 on the shin, staff was able to separate the residents. The physician and responsible party were contacted, as R1 did not have a history of physical aggression. This was evidenced by R1's plan of care and preappraisal. On 11/2/2022 R1 was found by staff next to R2, verbalizing that they would strike R2. The administrator was able to separate R1 and removed the cane from R1. Staff called the police, who took a report, but were unable to 51/50 R1. R1's responsible party was looking for alternate placement after the incident as reported by the administrator. On 11/4/2022 staff was sitting next to R1 in the living room when R1 struck R2. Staff was able to separate the residents. On this date R1 was moved out of the facility by their responsible party. Based on the on records reviewed, and interview with administrator it was found that the facility was providing sufficient care and supervision for R1 and R2. No deficiencies were cited at the time of the visit An exit interview was conducted where this report was reviewed and provided to Administrator, Val Paraiso.