Facility Evaluation Report

On 09/23/2025 at 2:30 PM, Licensing Program Analyst (LPA) Ardalan Gharachorloo and David Doidge arrived unannounced to conduct a case management regarding an incident report received by CCL on 09/15/2025.

LPA received an incident report regarding R1 experiencing a fall at the facility. R1 sustained a bump to the back of her head, resulting in hospitalization on 09/12/2025. The resident passed away on 09/15/2025.

LPA interviewed S1, who stated that the fall occurred in the common area. Caregivers were assisting other residents and called 911 immediately after the incident. LPA requested documents related to R1's care including but not limited to physician's report, care plan, and admission agreement. S1 stated she communicated with the daughter of the resident, who was notified when R1 was admitted to the hospital. LPA obtained a copy of the LIC500 and reviewed S1,S2, and S3's files.

No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided.