Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management-incident regarding an incident Resident R1 sustained an injury during transport. LPA Monter met with Administrator Caroline Mayo and stated the purpose of today's visit.

On March 27, 2026, the Department received an incident report, regarding resident R1, which stated the following. On 03/27/2026 at approximately 9:06 AM at Ruby Avenue San Jose CA 95148 while picking up R1, Staff S1 called the Administrative Assistant to report that R1 while in his/her wheelchair fell backward during transit.

At 9:08 AM: Program Manager called 911 as it was observed that R1 had sustained what appeared to be a cut to the back of his/her head and was bleeding.

At 9:45 AM: R1 was transported into the Regional Center Hospital by the Paramedics

At 11 AM: S1 returned to the day program where he/she was interviewed by Office Administration concerning his/her procedure securing R1 to the tie down. The Transportation Coordinator investigated the tie downs in the van and they were fully functional.

At 12:58 PM, Program Manager received an update from Care Home Admin and R1’s Family member who reported that R1 is at Regional Hospital, is being treated, the situation is stable and R1 is now resting. Care Home Admin reported that R1 had 7 stitches on the back of his/her head. The team is waiting for the MRI result.

At 2:47PM Care Home Admin called Program Manager that R1 was discharged from Regional and will be sending documents.