Facility Evaluation Report

Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced Case Management visit to follow up on an incident report received by Community Care Licensing on 01/30/2023. LPA identified herself and discussed the purpose of the visit with Executive Director (ED) Johanna Gonzalez.

Incident report dated 01/27/2023 indicated that on 1/22/2023 at 4:00 PM, MedTech was on her way to give medication to Resident 1 (R1) when she found out that R1 wasn't inside R1's room. Later MedTech was informed that R1's son, took R1 to ER for leg pain...R1's son informed community on 1/26/2023 that R1 sustained a fracture on pelvis and will be staying a few months in a Skilled Nursing Facility.

LPA Martinez reviewed R1's file, reviewed and obtained copies of Guest Sign In sheet for 01/22/2023; and R1's MAR for 01/2023. ED Gonzalez is unable to state when R1 was picked up by son. R1's sons name is not found on Sign in sheet for 01/22/2023. MAR shows R1 was given AM and afternoon medication on 01/22/2023. Also provided was a copy of Meal Attendance Report that shows R1 ask for Tray service for breakfast and lunch. R1's son picked up R1's belongings on 1/31/2023 and indicated R1 will not be returning to the facility.

Facility to gather detailed information on incident and forward to LPA Martinez by close of business day of 2/6/2023. Further follow up is needed. LPA Martinez will return at a later date to continue follow up on this incident. No deficiencies cited at this time.

Exit interview conducted and a copy of this report will be sent to email on file.