Incident investigation·October 26, 2023

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management - Incident visit to the facility. The LPA was greeted by Administrator Gary Lee and informed them of the reason for the visit. The purpose of today's visit is to address a self reported Unusual Incident/Injury Report (LIC 624) reported to CCL on 10/18/2023. The self reported Unusual Incident/Injury Report (LIC 624) pertains to an incident that occurred on 10/17/2023 regarding one Resident #1 (R1), and two staff (S1, S2). It was reported that after R1 was criticizing S1, S1 was witnessed by S2 throwing a diaper at R1, saying to R1 they were not going to help anymore, and loudly saying "Retarded People" as they were walking away. It was further reported S1 was suspended. During today's inspection, the LPA obtained pertinent documents and interviewed S1 (via phone call), R1 and the administrator. Staff and resident interviews revealed that the incident did occur, however S1 stated the diaper was thrown at S2 and that they stated "you are retarded" to S2. S1 acknowledges they should not be speaking in that manner to or in front of the residents. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC809-D). Exit interview conducted. Copy of report and appeal rights issued at the time of the visit.