Facility Evaluation Report

On 4/28/2025 Licensing Program Analyst (LPA) M. Garza completed an case management visit. LPA met with Administrator, Alex Zanin, explained reason for visit and was permitted entry into the facility. LPA toured facility and completed a health and safety check on residents in care. Residents were observed in common areas and in rooms.

This case management visit is being conducted for incident reports that were received by the Department that required additional information. LPA requested and reviewed residents files (physicians reports, needs and services plans, reappraisals, hospital discharge paperwork, special incident reports (SIR) and logging notes) for R1, R2, R3, R4 and R5.

Incident 1:The Department received an SIR for an incident that occurred on 1/8/25 for R1. During a shower R1 fell out of the shower chair and was complaining of right should pain. R1 was sent to the hospital and upon discharge was sent to Skilled Nursing Facility with a broken clavicle. Per SIR, R1 had UTI and possible pneumonia. File review of charting notes did not disclose any previous indications of change in condition. No deficiency cited for this incident.

Incident 2: The Department received an SIR for R2 for an incident that occurred on 2/21/25. Staff completed a 6am check on R2 and found them not feeling well. EMS was contacted and R2 was transferred to the hospital. Resident was treated for the flu. File review of charting notes disclosed on 2/14/25 R2 had a fall. On 2/13/25 it is noted R2 is "a bit off". On 2/15/25 it is noted R2 "not felling well". From 2/3/25-2/21/25 there were other residents ill. No SIR's received for illnesses by the Department. Deficiency cited per Title 22.