Facility Evaluation Report

On 07/31/23 Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced Case Management-Incident visit to this facility. The purpose of the case management visit was to follow up on a special incident report dated 07/12/23 and incident occurred 07/11/23.

It was reported that Resident#1(R1) f all due to the absence of supervision and had been hospitalized and treated with sutures. LPA interviewed Direct Care Staff (S1) and Assistant Administrator (S2) regarding the incident. During the course of investigation, LPA obtain digital copies of Individual Program Plans (IPP), Physician's Report, Discharge Documents, Doctor's Follow up Notes, Resident in Home Schedule and 24 hour Staff Schedule.

Based on the information obtained during the investigation there is evidence that facility staff assigned to provide one-to-one supervision of R1, failed to provide adequate care and supervision by leaving R-1 unattended on 7/11/23 . Deficiencies were issued on a Facility Evaluation Report / Lic. 809D. The Facility Assistant Administrator was advised, appeal rights given, and a copy of this report was issued.