Facility Evaluation Report

On 05/23/25 Licensing Program Analyst (LPA) Raymond Comer, conducted an unannounced case management visit. LPA met with the administrator and disclosed the reason for the visit.

This case management visit was conducted in conjunction with complaint investigation #31-AS-20250516141919 to address deficiencies related to the complaint.

During the initial complaint investigation, LPA conducted a facility records review and interviews with Administrator and Staff which revealed the following: On 5/05/25, an incident occurred in which Resident#2 (R2) committed an aggressive act upon Resident#1 (R1). Staff contacted the Primary Care Physician for both R1, and R2. Additionally, staff informed responsible family members of R1, and R2 concerning the incident. However, staff did not report to issue to the the Administrator, and as a result, the facility did not submit an incident reports or other required reports to the Licensing Division.

At the time of this visit, the Administrator was informed that staff are not following reporting requirements and failed to follow Tittle 22 reporting requirements.

Deficiencies are cited on the corresponding 809-D page.

No immediate health or safety hazards were observed during today's visit. Exit interview conducted.

Appeal rights discussed. Copy of report provided.