Incident investigation·February 22, 2022

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Case Management – Incident visit at 11:12AM for the purpose of following up on a self-reported incident and to ensure resident health and safety. LPA arrived and met with facility designee Flordeliza "Baby" Hipolito. Entrance interview conducted. On 02/20/2022, LPA received a text message from the Administrator Becky Spring indicating there had been an incident at the facility on 02/19/2022. Administrator indicated Ventura County Sheriff's Department had been notified of the incident that occurred between two residents and had taken a report on the date of the incident. On 02/22/2022, the Woodland Hills Adult and Senior Care Regional Office (RO) received an incident report stating that on 02/19/2022 at approximately 9:00 AM, Resident #1 (R1) and Resident #2 (R2) were outside in the smoking patio when R1 stabbed R2 with a knife. During today's visit, LPA Dulek interviewed facility designee at 11:15AM, toured the facility with facility designee at 11:45AM, reviewed staff and resident records at 12:00PM, and received copies of pertinent documents. During file review, LPA discovered that staff #1 (S1) is not associated to the facility. File review and interview revealed that S1 began employment at the facility on 12/17/2021. LPA determined that further investigation is needed regarding the Incident. LPA informed Facility Designee that Community Care Licensing Division's (CCLD) Investigation Branch (IB) Investigator and/or LPA will return to the facility at a later date to continue the investigation. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Civil penalties assessed in the amount of $500.00. Exit interview conducted. Today's reports, civil penalty, and appeal rights were reviewed and issued.