Incident investigation·August 23, 2021

On 8/23/2021, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to follow-up on an incident reports/ SOC 341 that was reported by the facility. LPA Han met with the Executive Director, Fili Howard and explained the purpose of the visit. The incident happened 8/17/2021 around breakfast time, when the Medication Technician who was preparing medication in the dining room, he/she heard a loud and witnessed that R1's right arm was extended upward in a swinging motion and R2 was on the floor. The staff reported that R2 has a tendency of grabbing other resident's foods and R1 was trying to stop R2 from grabbing R3's food. During the visit, LPA interviewed the Executive Director, the staff members who were in the dining room during the incident, and the residents who were involved in the incident. In addition, LPA observed the dining room area and requested for additional documentation for the residents who were involved. This incident requires further investigation. This report was reviewed and discussed with the Executive Director and a copy is provided.