Facility Evaluation Report

On 10-9-24 at 2:45pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding a previous resident to resident altercation reported by facility on 9-6-24. LPA met with lead staff Jovencita Castillo and explained the purpose of the visit. Licensee Nellen Van De Pol was made aware of LPA's visit and purpose via phone. LPA reviewed physician's report for resident1 (R1), and Physician's report and needs and services plan for R2. LPA also conducted brief interview with staff1 (S1) and R2.

Based on incident report and interviews, it was determined that on 9-3-24 at approximately 3:00pm, R1 and R2 were engaged in a physical altercation. S1 was on duty for supervision and heard a noise described as a falling object from the room shared by R1 and R2. S1 immediately entered the room and observed R1 holding his face. Additionally, S1 observed a spot of blood on both sides of R1's face and a small bruise mark on the front of R1's nose. S1 inquired with R1 and R2 as to what occurred and was told by R1 that R2 punched him in the face unprovoked. S1 immediately separated both R1 and R2 and called local law enforcement at approximately 3:15pm . Administrator was notified by S1. Licensing department and Ombudsman were notified within regulatory time frames. R1 was sent to the hospital and returned with medication due to a broken nose bridge. Both R1 and R2 were monitored by staff for any potential escalation of behaviors after the incident. It was further determined that R1 moved out of facility on 10-1-24 and no longer has any contact with R2.

As a result of today's case management, no citations are issued. An exit interview was conducted with lead caregiver and a copy of this report was provided to lead caregiver.