Facility Evaluation Report

Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced case management visit in response to Special Incident Report (SIR) that describes the incident of Resident R1 that occurred on 01/17/2026. LPA met with Administrator Maria Jacobo and explained the purpose of the visit.

LPA Interviewed Administrator Maria Jacobo during the visit and reviewed Resident R1's file.

Facility submitted R1's Identification and Emergency Information, Physician's Report dated 10/2/2025, Appraisal Needs and Services Plan dated 2/15/25, Medication Log for January 2026, and Admission Agreement.

SIR stated that there was a loud noise and 2 staff ran outside and observed a police car had crashed into the street light in front of the facility and on the floor was Resident R1.

Resident did not respond when staff called out R1's name.

911 was called and ambulance came within seconds.

R1 was taken to L.A. USC County Hospital and is currently still there.

Administrator Maria Jacobo confirmed that R1 was hit by the police car just steps in front of the facility.

Also stated that R1 was still in the hospital and is receiving updates from family member of R1 and will also notify Licensing of R1's status going forward.

Physician's Report dated 10/2/2025 is checked off Yes for being able to leave the facility unassisted.

Exit interview conducted and copy provided.