Incident investigation·October 14, 2021

Licensing Program Analyst (LPA) Lopez arrived unannounced for the purpose of following up on an incident involving a self reported incident submitted to Community Care Licensing (CCL). On 9/28/21 an SOC341 was sent to CCL regarding R1 aggressive behavior towards R2 twice in the same day. Facility failed to ensure resident was accorded a safe environment being hit by R1 back to back. LPA requested documents and conducted interviews with staff and Administrator. LPA requested documents for both residents: Physician Report, Appraisal, and Care Notes. R1's Physician Report dated 6/5/21 states that R1 has aggressive behaviors. Current Care plan dated 6/22/20 for R1 does not address aggressive behavior. Administrator contacted police, CCL and Ombudsman. Administrator stated that R1 and R2 have had previous incidents and decided to move R1 to a different location in facility. Responsible party was notified and agreed for R1 to be moved. During visit, LPA noticed another incident 9/17/21 when reviewing R1's Care Notes. R1 was aggressive towards R2. Facility failed to report incident. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with, Administrator, Melody Lee-Allmond and appeals right given.