Incident investigation·January 26, 2024

Licensing Program Analyst (LPA) Olson conducted a Case Management - Incident visit to issue deficiencies on an incident the facility self reported. LPA met with Administrator and Licensee and explained the purpose of the visit. LPA toured the facility with Administrator. CCL received an incident report on 12/7/23 stating that on 12/4/23 a hospice staff observed Staff 1 (S1) used unnecessary roughness or unnecessary force to ensure Resident 1 (R1) remained in a recliner chair as they attempted to get up out of the chair. The incident report states hospice personnel contacted the Licensee to notify them of the incide nt, and S1 was terminated by the Licensee. LPA interviewed Licensee who stated they reviewed the video footage of the common areas in the facility, and observed S1 “shove/push” R1 back into the recliner. Licensee stated they decided to terminate S1 based on the actions. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). An exit interview was conducted, a copy of the report and appeal rights were issued.