Facility Evaluation Report

On 04/29/26 Licensing Program Analyst (LPA) Villegas conducted a case management visit in response to Special Incident Report submitted to CCLD on 04/28/26 for allegation made on 04/27/26; regarding Resident #1 (R1). LPA met with DeAnthony Hardiman as the purpose of the visit was explained.

During case management visit LPA Villegas conducted a Health & Safety visit which consisted of the following: tour of the physical plant and obtaining copies of the following records for R1: Emergency ID form, Admission agreement dated: 11/14/24, Physicians report dated 01/28/25, Needs and service Plan dated:04/03/25, and individualized restricted health care condition care plan dated: 12/25/25. LPA also obtained copies of the staff and Resident rosters. On 04/29/26 LPA conducted interview with S1-S4 regarding the allegation above. On 04/29/26 LPA attempted to conducted interview with R1, however LPA was unsuccessful due to communication barriers. On 04/29/26 LPA conducted telephone interview with witness #1-2 (W1-W2).

Due to insufficient information available at this time, the above allegations need further follow-up.

No immediate Health & Safety issues were observed.

Exit interview conducted, and a copy of this report was provided.