Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to deliver findings on an investigation conducted regarding an incident report received by the Department on March 24, 2025. LPA was greeted and granted entry into the facility and explained the reason for the visit.

Per the Incident report, on March 17, 2025, Resident 1 (R1) had been found on the floor with a red eye and blood on their nose. 911 was called and the resident was transported to the Hospital where resident was diagnosed with a closed blowout fracture of right orbital floor, fracture of L5 lumbar vertebrae and a fractured rib and left clavicle.

The resident moved to Belmont Village Assisted Living on July 31, 2023. Per pre-placement appraisal dated August 03, 2023, R1 required minimal assistance for activities of daily living (ADL’s). Per physician report dated March 24, 2025, R1 had a diagnosis of Parkinson's Disease, Progressive Supranuclear Palsy (A rare, degenerative brain disease that affects movement, balance, and eye control) and had mild cognitive impairment. R1 utilized a walker for mobility. On October 24, 2024, facility staff noticed a change in condition as the resident became more confused and disoriented while becoming progressively unsteady and beginning to have falls. R1 began to fall in November 2024, without injury, and was initially re-assessed December 10, 2024. Resident was subsequently re-assessed four more times between December 10, 2024, and March 20, 2025, after additional falls. Management had R1 medically evaluated by a mobile physician who visited the facility two to three times weekly checking on residents including R1. The physician adjusted R1’s medications and staff continued to monitor them for changes. Continued on LIC 9099C DATED 05/08/2026