Facility Evaluation Report

Licensing Program Analyst (LPA), Janet Ngallo conducted a Case Management - Incident visit. LPA met with Executive Director, Megan Franz and discussed the purpose of the visit.

Community Care Licensing received a self-reported Incident Report involving Resident #1 (R1). The Incident Report stated that R1 had an unwitnessed fall on 12/15/2025 resulting in hospitalization. R1 was placed on hospice during their time at the hospital, and on 12/21/2025, R1 passed away.

Today, LPA conducted a brief tour of the facility and requested records relevant to the Incident Report. No deficiencies were cited during today's visit. An exit interview was conducted and a copy of this report,

the LIC811 Confidential Names List, and the Licensee Rights (LIC 9058 03/22) were provided to Megan Franz whose signature below confirms receipt of these rights.