Facility Evaluation Report
On 04/07/2025 at 1:25 PM Licensing Program Analysts (LPAs) P.Manalo and and K. Nguyen conducted an unannounced Case Management visit regarding a self-reported incident. Health Services Director self-reported the incident on 03/15/2025. LPAs met with Health Services Director, Leslie Ibo, and explained the purpose of the visit.
LPA received a self-reported incident report from facility that indicated Resident 1 (R1) had an unwitnessed fall and after visit summary stated that the resident had a closed T11 fracture.
LPAs obtained the following documents such as R1's Physician's Report from move in date, Emergency ID Face Sheet, and After Visit Summary from 03/15/2025.
LPAs record review indicated that R1's Physicians Report and Emergency ID Face Sheet indicated that R1 had sustained a unspecified fracture prior to moving in.
Exit interview was conducted with Health Services Director, and a copy of this report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction