Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Martinez conducted a Case Management visit to the facility to obtain information pertaining to a self reported incident for an unwitnessed fall involving resident 1 (R1). The facility submitted the Incident report on 8/20/25. The report indicated that the incident occurred on 08/15/2025.

LPA observed various residents throughout the facility. Residents in care appeared to be safe; no imminent health/safety concerns were observed. LPA inspected the inside of facility, and living spaces. Facility appeared to be clean and organized. LPA inspected outside perimeter of facility, to ensure no health/safety hazards were present. The needs of the residents in care appeared to be met during LPA's inspection. Residents appeared to be groomed appropriately and no visible injuries noted.

LPA obtained copies of pertinent documents. R1 after incident had a reappraisal and level of care of adjusted. LIC602 physician's report indicates R1 may leave independently with no escort, using public transportation or walking where desired. May drive own vehicle. R1's date of admission is 3/5/22 and this was the first fall R1 had since move in. R1 has had no other incidents since and was observed doing activities during the visit.

Based on the information obtained during today’s visit, no citations are being issued during today’s visit. An exit interview was conducted, and a copy of this report was left at facility.