Facility Evaluation Report

Licensing Program Analyst (LPA) David Roman conducted an unannounced Case Management Inspection. LPA D. Roman identified himself to Facility Manager, Gabriela Zamora, and discussed the purpose of the visit.

LPA D. Roman reviewed the resident records and intake assessment which identified the resident entered the facility with a fractured tibia or fibula on 01/09/2025. LPA D. Roman conducted staff interviews which revealed the resident fell in the dinning area and refused to receive medical treatment on 10/12/2025.

LPA D. Roman along with facility staff toured the interior and exterior of the facility and inspected bedrooms and bathrooms. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. LPA D. Roman observed the dining area where it was reported that the resident fell to be free of obstruction. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

An exit interview was conducted with Facility Manager, Gabriela Zamora. A copy of this report, along with Licensee/Appeal Rights, was provided to them at the conclusion of the visit. Their signature on this form acknowledges the receipt of this report and their rights.