Facility Evaluation Report

Licensing Program Analyst (LPA) Amy Goldenberg is conducting this case management visit to address deficiencies in conjunction with complaint control number 18-AS-20220118141100 which were discovered through investigation that were not part of the initial allegations. The facility failed to meet the reporting requirement regarding R1's fall on 10/14/2021 and subsequent death within the regulatory time frame.

See LIC908D for deficiency cited. This report was reviewed with a copy was provided to the facility representative.