Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to conduct follow up regarding an incident. LPA was greeted by, identified herself to, and explained the purpose of the visit with General Manager Karl Miller.

On 10/15/2025, the Department received a self-reported incident report from the licensee that described an incident that occurred on 10/9/2025. The incident report described that Resident 1 (R1) had a fall in their room, alerted staff via call pendant, staff assessed resident and called 911. [General Manager provided with LIC811 Confidential Names List to identify R1] R1 was transported to the hospital, received medical treatment, and was admitted for multiple days. Upon returning to the facility on 10/11/25, R1 notified facility management that some jewelry was missing from their room. Facility management and R1 notified local police department's office of the alleged theft and facility management conducted multiple searches of R1's room with R1 present.

During today’s visit, LPA observed residents in care, spoke with General Manager, and reviewed and obtained facility records. Additional visits may be necessary in regards to this incident.

No deficiencies were cited on today’s date. An exit interview was conducted with General Manager Karl Miller, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).