Facility Evaluation Report

On 9/27/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a case management regarding an incident report received from the facility listed above. LPA introduced herself and explained the reason for the visit. LPA was allowed entrance into the facility. LPA met with Sister Astrida D. Cruz (SAC) and Basuny Eldaouch (BE- New Administrator)

The Dept. received an incident report stating caregiver found R1 to have a swollen ankle on 9/15/2024 and it was reported. R1 previously had a fall the week before. Basuny Eldaouch stated he spoke with the doctor who stated the fracture may have occurred due to R1 hitting their ankle while walking with the walker. No previous reports were submitted regarding the fall prior to 9/15/24.

LPA interviewed R1. LPA was shown incident report for a fall on 8/7/2024 which was not previously reported to the Dept. R1 previously had a fall prior to the ankle swelling, report was not provided to the Dept.

SAC & Basuny Eldaouch were informed of the reporting requirements. Citation was issued under Title 22, Division 6, Chapter 8.

Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Basuny Eldaouch.