Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Case Management - Incident visit in regards to an Incident Report the Department received on 04/03/2026. LPA met with Administrator, Matt Zahodne and stated the purpose of the visit.

On 04/03/2026, the Department received an LIC 624 Incident Report stating on 03/28/2026, resident R1 had an unwitnessed fall in R1's room wherein R1 had blood on R1's right arm. R1 was taken to the hospital and resident returned to the facility the same day.

During today's visit, LPA Rai conducted interview with Administrator.

LPA Rai obtained copies of the following documents to included but not limited to R1's LIC 602A Physician's Report and R1's Appraisal/Needs and Services Plan.

At this time, this case in under review and the Department will conduct a follow up visit, if warranted.

This report was reviewed with Administrator, Matt Zahodne and a copy of the report was provided.