Facility Evaluation Report

On June 30, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced Case Management visit to follow-up on an incident that was reported by the facility. LPA met with the administrator and explained the purpose of today's visit.

On June 9, 2026, the facility reported that at 12:58PM, facility staff observed R1 was on the floor in the common area and noted with bleeding from his/her left eyebrow and nose. Subsequently, the administrator viewed the camera footage and observed resident #2 (R1) touched R2, R2 reacted by pushing R1 resulting in R1 fell on the floor and sustained the injuries.

During today's visit, LPA toured the Memory Care Unit where R1 and R2 resides. LPA observed R1 was eating and R2 was actively participating in activities. LPA observed both residents appeared with bright affect and both of them stated that they did not remember the incident.

LPA interviewed staff members and they reported that they were aware of the incident and they were monitoring both residents more closely and separate them when necessary. They also reported that there were no additional incidents between R1 and R2 after the incident on 6/9/2026.

After the incident, the facility obtained medical attention for R1, informed both resident's responsible parties of the incident.

This report is reviewed and discussed with the administrator and a copy is provided.