Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to deliver the results of a complaint investigation (26-AS-20251110154451). The purpose of this case management -other visit was to review and address concerns identified during the investigation of the above referenced complaint that are unrelated to the allegation. LPA met with Administrator, Meghian Geul .

During the complaint investigation, R1’s facility file record was reviewed and identified multiple documented falls and injuries involving R1 from 8/21/25 to 11/8/2025. Based on interview with ADM, ADM admitted that the required incident reports were not submitted to CCLD within the regulatory 7 days time frame.

The Department reviewed R1’s Charting Notes (CN) with the following noted observations:

On August 21, 2025, S2 observed discoloration on R1’s right lower leg and forehead that was a few days old, wherein R1 stated he/she had hit his/her head and denied falling.

On October 23, 2025, R1 reported he/she had lost his/her balance and hit his/her head and sustained a bruise on his/her right check and right side of his/her chin.

On October 24, 2025, Staff noted that R1 stated he/she bumped his/her head on the coffee table. R1 said the bruise to his/her face and chin was from a fall a few weeks ago.

On November 8, 2025, staff and Witness W1 noted R1 had fallen around 1:20pm. Later in the evening, around 7:15, R1 was found on the floor by a care giver. S6 assessed R1, who stated he/she had hit his/her forehead. Continuation on LIC 809-C, Page 1 of 6.