Facility Evaluation Report

On 7/20/2026 at 12:50 PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a case management visit regarding an incident report, SOC 341, self reported by the facility. LPA met with Executive Director (ED) Janice Gombio.

LPA K. Nguyen conducted an interview with ED regarding the self reported incident that occurred on June 6, 2026, involving R1 and R2, who had an altercation. R1 and R2 were both ambulatory and able to verbalize. R1 came out of R1's room and reported that R2 hit R1. Immediately, ED staff came and separated R1 and R2, reassured R1 and R2 that they were in no harm. R1 wanted to go out, but staff redirected R1 because R1's partner is coming to visit. R2 was reassured that they would be moved to a different room. LPA reviewed documents including but not limited to 72-hour charting, updated services plan, including interventions to prevent the incident from happening, communication with R1 and R2 doctor. LPA toured the facility, including the residents' rooms, and confirmed that R2 has been moved out of R1's room.

An exit interview was conducted, and a copy of the report was provided.