Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai arrived unannounced to conduct an case management visit to follow up on Incident Report/Death Report for resident (R1) who sustained injury from an unwitnessed fall and passed away at the hospital. L PA Rai met with Executive Director (ED) Brenda Ritter and stated the purpose of today's visit.

Today, the Department received an Incident Report for an incident which occurred on 6/20/2025 wherein R1 had an unwitnessed fall in resident's room in the Memory Care unit. R1 stated the right side of the body and head was "hurting". The facility staff called the paramedics and R1 was taken to the hospital.

Today, the Department received a Death Report wherein R1 passed away at the hospital on 6/20/2025 and the immediate cause of death is unknown.

LPA Rai obtained copy of the following documents which included but not limited to R1's Physician's Report, Service Plan Report, Evaluation and progress notes.

At this time, LPA Rai determined this case management needs further investigation.

The report was reviewed with Executive Director (ED) Brenda Ritter and a copy of the report was provided.