Facility Evaluation Report

Licensing Program Analyst (LPA) Loera arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, Wally Hyppolite. The purpose of the visit was to follow up on self-reported incident that was submitted to Community Care Licensing (CCL).

CCL received an incident report on 08/27/2025. Report states on 08/21/2025 at around 11AM client (C1) told staff that their back was hurting. C1 was given 500 mg Acetaminophen. At 12PM, C1s pain intensified. Staff took C1 to the emergency at Novato Community Hospital. There at the hospital an X-ray and MRI revealed two fractured ribs. The hospital reported the case to APS. It was later upon leaving the hospital at 7:45PM, when C1 finally admitted that he had fallen by the TV in their room and injured their back.

Based on conversation with administrator, they took C1 to the hospital after C1 stated their back/rib area was hurting. Administrator stated C1 wasn't acting like his usual self and decided to take C1 to the hospital to get evaluated. It is unsure when exactly C1 had the fall as no staff heard and the fall was not witnessed. Per conversation with administrator C1 does not talk as much. C1 had a follow up visit on 08/23/2025. C1 has a follow up visit with their primary doctor on 10/31/2025.

Exit interview conducted. Copy of report and LIC811 (Confidential Names) discussed and provided to Administrator.