Incident investigation·October 22, 2021

THIS IS AN AMENDMENT. THE INSPECTION WAS CONDUCTED ON 10/29/2021 AND THE ORIGINAL FACILITY EVALUATION REPORT WAS SIGNED BY THE LPA AND THE FACILITY DIRECTOR ON THE DATE OF THE INSPECTION ON 10/29/2021. HOWEVER, THE VISIT DATE AT THE TOP OF THIS REPORT WHICH IS NOT EDITABLE SHOWS 10/22/2021 WHICH IS INCORRECT. THIS AMENDMENT IS TO NOTE THE CORRECT DATE OF THE INSPECTION. THIS REPORT WAS SIGNED AGAIN BY BOTH PARTIES ON 11/1/2021, THE DATE THIS AMENDMENT WAS ISSUED. Licensing Program Analyst (LPA) Kim Leung conducted a case management visit at the facility this date on 10/29/2021 in response to the receipt of an unusual incident report (UIR) from the facility regarding possible personal rights violation. The UIR was received by the licensing agency on 10/19/2021. Upon arrival, LPA met with facility director Jennifer Diehl and stated the purpose of the visit. Facility records were reviewed and interview was conducted. Further information is needed. Upon completion of the review, the outcome and/or recommendations will be provided to the director. An exit interview was conducted with director Jennifer Diehl and a copy of this report was provided to facility staff. Notice of Site Visit was issued and must be posted up at the facility for 30 days. A copy of this report must be made available to the public, at the facility site, for 3 years.