Incident investigation·August 26, 2022

Licensing Program Analyst (LPA) Hansen conducted an unannounced case management and met with Camille Brown, Interim Executive Director. The purpose of this case management inspection is to follow up on 2 self reported incident reports and an SOC 341 submitted to Community Care Licensing (CCL). CCL Received two self reported incident reports and an SOC 341 form on 8/16/2022 reporting first on 8/12/2022 at 4:40 PM staff (S1) reported to have witnessed resident (R1) hit R2 three times in the face. While R1 was being redirected by S1, R1 struck R3 in the shoulder, Medtech was able to step between residents and R1 struck Med tech three times in the back and spit in Med tech’s face. R1 was redirected and given PRN. POA’s and PCP’s were notified. Second self reported incident report received on 8/16/2022 was regarding an incident that occurred on 8/14/2022 at 5:30 pm where R1 threw dinner plate at R4. While staff was redirecting R1, R1 spit in staffs face. R1 was seen at the ER with new medication orders. Med tech on duty evaluated all residents and no injuries were noted. Submitted reports cross reported to Ombudsman, and later to Petaluma Police Department, and responsible parties notified. Law enforcement report states no crime due to R1’s mental state. Alert monitoring, medication review and change, Care conference, POA arranged a 1:1 companion for a week and has since given notice to facility R1 will be moved out. LPA made copies of records, conducted interviews and made observations. No deficiencies cited during today’s inspection.