Incident investigation·August 16, 2023

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by and identified himself to Caregiver Brandon Navasak. LPA then met and discussed the purpose of the visit with Licensee Siera Navasak, who arrived later during the visit. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office on 05/31/2023, involving Resident #1 (R1) and Staff #1 (S1). [See LIC 811 Confidential Names List for a description of person identifiers used in this report]. During today’s visit, LPA performed a facility tour and welfare check, interviewing R1 and verifying that they were safe and uninjured. LPA also collected pertinent records and interviewed relevant staff. Records and interviews showed: While S1 assisted R1 in the shower on 05/29/2023, S1 cut R1’s hair, against their will and protest. This caused R1 to be sad/upset. When licensee interviewed S1 about the incident, S1 admitted to doing this. Also, during one prior occasion in late 2022, Staff #2 (S2) had also cut R1’s hair, against their will. Personnel records showed that licensee had disciplined S1 and S2, following each respective incident. As of the date of LPA’s site visit, neither S1 nor S2 were still employed at the facility. A preponderance of evidence exists to show that licensee’s staff (S1 and S2) did not treat a resident (R1) with dignity. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). Since the deficiency is a repeat violation within a 12-month period of time, a civil penalty of $250.00 was also assessed (refer to the LIC 421-FC). A Plan of Correction was jointly developed with the licensee. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] An exit interview was conducted with Siera Navasak, to whom a copy of this report, the LIC 809-D, the LIC 421-FC, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.