1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 | Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced case management visit. LPA was granted entry into the facility by Robin Mendez, Director of Health Services, with whom she disclosed the purpose of the visit.
Today’s visit was in response to an incident which licensee self reported via an LIC624 and SOC341 Incident Report received at the Community Care Licensing Regional Office on November 22, 2024. The report described Resident #1 (R1 – See LIC811 Confidential Names List for identification), complained of a staff member not locking R1's wheelchair prior to transferring R1 to R1's wheelchair. R1 stated that R1 fell to the floor and the staff assisting R1 left the room.
LPA briefly toured the facility, performed a welfare check on residents in care, interviewed resident and staff, and obtained copies of pertinent facility records. Further investigation is needed, interviews with staff and outside sources are needed prior to completion of the case management visit.
An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (03/22) were left with the Robin Mendez, whose signature on this form confirms receipt of these documents. |