Facility Evaluation Report

On this day, July 2, 2026, at 10:40 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management visit as a result of the Department receiving an Unusual Incident Report (UIR) for resident (R1). The Department received the UIR on June 25, 2026. LPA met with Executive Director Geraldine Tayo.

UIR indicated R1 was found on JUne 23, 2026 on terrace lounge laying on their back with laceration on the head near eyebrow and was bleeding. R1 fell and hit head on the chair's arm rest. First aid was given to stop the bleeding and 9-11 was called.

LPA conducted interview, reviewed resident record and obtained copies of following documents: LIC602A Physician's Report; Resident Appraisal; LIC625 Appraisal/Needs and Services Plan; After Visit Summary. LIC602A Physician's Report indicated R1 able to bathe (with supervision), dress/groom and feed self, able to leave the facility unassisted and communicate needs.

Exit interview conducted and copy of this report provided.