Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on an incident report dated 11/30/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit.

Incident report dated 11/30/2025 indicated Resident 1 (R1) was walking down the hallway and fell. Maintenance Tech found the resident unresponsive at 10:45 AM and 911 was called. Resident was pronounced deceased at 11:00 AM at the facility.

Physician report dated 02/06/2025 shows resident is diagnosed with Dementia. Facility notes indicate resident has had multiple falls in the facility.

Facility to provide a copy of the death certificate upon receipt.

LPA observed no health or safety concerns during today's visit.

Exit interview conducted and a copy of this report was left at the facility.

*This is an amended report to reflect a change in verbiage.