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 Executive Director James Arp and Assistant Executive Director Donnie Johnson.

Community Care Licensing received an Incident Report on 8/6/25 in which it was reported that on 7/20/25 staff responded to a resident fall. Per the report, the resident, identified as R1, was found sitting on the floor with a laceration to the head and a bruise with swelling on the right lower extremity. Emergency services were contacted and R1 was taken to the hospital where they were treated for a C2 fracture, nose fracture, and right ankle fracture. R1's Responsible Party and Primary Care Physician (PCP) were notified.

During today's visit, LPA conducted file review, interviews, and provided consultation with Executive Director Arp. A health and safety visit with R1 could not be conducted as R1 has since passed away.

No Deficiencies were cited during the visit as the facility responded accordingly and appropriately. An exit interview was conducted with Executive Director Arp to whom a copy of this report was provided. Their signature below confirms receipt of this document.