Facility Evaluation Report

On 10/2/2023 at 2:15 pm, Licensing Program Analyst (LPA) Lourdes Montoya made an unannounced case management visit to obtain additional information regarding an Unusual Incident/Injury Report at this facility. LPA was greeted by Staff Brenda Real who confirmed the facility is free of Covid-19. LPA explained the purpose of the visit. Staff Real called the Program Director Vincent Nguyen and Nguyen assisted with the visit via telephone.

LPA requested and obtained copies of Client #1’s records pertinent to the incident: Annual IPP dated 4/27/2023, Behavioral Program report dated 2/23/22-4/20/23, Behavioral Intervention dated 4/11/2023, and Emergency Room After Visit Summary dated 9/30/23. Nguyen will email other pertinent records.

Program Director Nguyen and Staff Real explained C1 sustains bruises from falls, unbalanced gait, age and maybe combination of these.

LPA explained the department will review C1’s records and will conduct a follow-up call or visit if needed.

Exit interview conducted and a copy of the report was provided to Staff Brenda Real.