Follow-up·December 28, 2022

Licensing Program Analyst (LPA) Kayla Hilario conducted an unannounced Case Management Visit. LPA was allowed entry by the receptionist. LPA met with, identified herself, and disclosed the purpose of the visit with Resident Services Director Lilllian Escobar. Today's visit is in response to the self-reported incident which occurred approximately around 11/14/2022 regarding an incident between Staff 1 (S1) and Resident R1 (for a description of S1 and R1 - see LIC811 Confidential Names List). LPA conducted a wellness check at the facility by interviewing staff, a private caregiver, and R1. LPA observed that the residents in care appeared appropriate for the facility. LPA also collected resident records. The facility staff have conducted their own investigation and while inconclusive, have determined that S1 will not work with R1 moving forward. No deficiencies were cited or observed on this date. An exit interview was conducted with the Resident Services Director Lilllian Escobar. A copy of this report and appeal rights (LIC9056 03/22), were provided via hardcopy.