Facility Evaluation Report

On 12/2/2025, Licensing Program Analyst (LPA) Murial Han conducted a 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 11/18/2025, the facility reported an incident that happened on 11/16/2025 concerning resident #1 (R1) who was transferred to the hospital after staff observed R1 complained about left shoulder pain and could not bear any weight. R1 could not report what happened and denied any recent falls. R1 stayed at the hospital for a few days and returned with diagnosis of fracture.

During today's visit, LPA interviewed the administrator who stated that R1 returned from the hospital and is currently under hospice care. The administrator stated that R1 had a private caregiver before and after R1's hospitalization. When the injuries were discovered, R1's private caregiver was on-site. The administrator stated that there was no report that R1 fell recently and R1 denied falling. The administrator also stated that there were no incidents that happened which could have resulted in the injuries.

LPA observed R1 who appeared to be comfortable in bed with a private caregiver in the room. R1 did not remember what happened and reported that he/she did not have any pain and was comfortable.

This report is reviewed and discussed with the administrator.