Incident investigation·October 27, 2021

Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced on 10/27/2021 at 8 am to conduct an unannounced case management visit following an incident report submitted to the department. LPA met with Administrator and stated the purpose of the visit. Current census is 10. During the visit LPA conducted interviews and reviewed records. LPA reviewed record of one incident where Resident one (R1) was observed to show behaviors off baseline of attempting to burn clothes. R1's responsible party and physician was notified. R1 admitted to hospital for evaluation and symptoms resolved after medication administered per physician's orders. R1 observed regularly was revaluated after incident and will follow increased appointments. Administrator stated the facility will continue to provide increased monitoring and coordination for psychiatric appointments to observe R1 for changes in conditions. LPA observed physician's report last updated in 12/2015. LPA provided technical assistance to update physician's assessment and document updated care plan to ensure R1's increased monitoring is documented and available for records review. LPA conducted a case management inspection to ensure proactive measures were put in place to prevent further incidents. If there is another reoccurrence of the same nature the department will require resident be reassessed by their physician to determine if the current placement continues to be appropriate. Per the California Code of Regulations, Title 22, no deficiencies observed or cited. Exit interview held, copy of report given.