Facility Evaluation Report

On 01/10/2024 at 2:14 p.m. Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced case management - deficiencies visit in conjunction to complaint control number #31-AS-20240103123503 . During complaint investigation, the following was discovered:

During interviews with staff it was revealed resident was sent to the hospital with an injury to his right hand and resident #1 (R1) had reported the injury was caused by an altercation with another resident. Staff report the administrator was notified but a special incident report was not submitted to the department. LPA could not find a report made by the facility in the regional office database. Administrator confirmed they did not submit a special incident report.

Deficiencies issued (refer to LIC809D). Civil Penalty assessed and issued (refer to LIC 421FC). Exit interview conducted. Appeal Rights provided. A copy of report was provided.