Facility Evaluation Report

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to follow up on an incident reported to Community Care Licensing. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Activities Director Gabriela Ortiz.

Community Care Licensing received an Incident Report on 8/14/25 in which it was reported that staff responded to a call for help and found Resident #1 (R1) on the floor. Per the report, R1 stated they tried to pick up their phone from the floor and fell, sustaining a scratch to the head. R1 was assisted back into bed by staff and PRN (as needed) medications were administered per resident request for pain. Later that night, R1 reported severe pain in their hip and staff contacted emergency services who transported R1 to the hospital where they were treated for a hip fracture. R1's Responsible Party and Primary Care Physician (PCP) were notified.

During today's visit, LPA conducted interviews, file review, a health and safety visit with R1, and consultation with Activities Director Ortiz.

No Deficiencies were cited during the visit. An exit interview was conducted with Activities Director Ortiz to whom a copy of this report was provided. Their signature below confirms receipt of this document.