Facility Evaluation Report

On 02/03/2026 at 2:10 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. Health Services Director, Leslie Ibo, self-reported the incident on 01/07/2026.

LPA received a self-reported incident report from facility that indicated Resident 1 (R1) had and witnessed fall while R1's private caregiver was escorting R1 to the bathroom in R1's room on 01/03/2026. Incident report revealed that R1 attempted to push the private caregiver away which resulted in R1's fall. R1 was sent to the Emergency Room and was diagnosed with a hip fracture. R1 is currently at a skilled nursing facility (SNF).

LPA reviewed the following documents including but not limited to R1's Physician's Report, communication log with family and doctor's, service plan, call pendant alert log, private caregiver contact information, Home Health Visit Communication form, staff roster/ schedule, staff contact information, and resident roster.

Interview with Ibo indicated that a new physician report will be obtained and sent to CCLD when R1 is discharged from the SNF. Additionally, Ibo followed up with the SNF that revealed that there is no discharge date and R1 is undergoing physical therapy.

LPA may return at a later time. No deficiencies cited during visit.

Exit interview was conducted with Health Services Director, and a copy of this report was provided.