Complaint·October 12, 2023

Based on interview with the Licensee, the panic proof doorknobs were implemented about two weeks ago from 04/05/2023. A different set of doorknobs were installed after the HCBS final rule was implemented, which was observed by another State agency. The set of doorknobs observed by another State agency were not a “panic lock” and required the residents to unlock the door by turning the button from the inside. The staff had a key to each bedroom. Licensee states there are / were no residents being locked in their bedrooms during the night. The facility does not have a resident who has wandering behaviors. Based on interview with the staff (S2), the facility does not have a resident with wandering behavior during any time of the day. S2 states none of the residents are being locked in their bedrooms but the residents can lock their doors for privacy if they want. S2 states the staff has a key to each bedroom in case of an emergency. The facility has live-in staff on premises and the residents know where the staff resides in case they need anything during the night. Residents are also being checked on during the nighttime. Based on resident interviews, R2 states to have never been locked out of his/her room or locked in his/her room. R1 was able to communicate with LPA but was unable to answer the questions asked. Two residents (R1 – R2) successfully demonstrated how to unlock their bedroom door. The review of resident records shows that R1 – R3 does not have wandering behavior and are able to follow instructions. Correspondence shows the facility was in contact with another State agency regarding guidance on the implementation of locked doorknobs in the resident’s bedrooms. The facility was asked to place the lock doorknobs back to be in HCBS compliance. The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee, Azucena “Sandy” Zipagan and a copy of the report was provided.