Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Riley Tucker and Ben Roedel.

The purpose of the visit was to respond to an Incident Report (IR) that the facility submitted to the department on 01/08/2026. The IR stated that on 12/31/2025 at around 9:00 AM, staff S1 was assisting resident R1 to the bathroom. S1 briefly left R1 in the bathroom to provide assistance to another resident. Before leaving R1, S1 told R1 to push the emergency call light inside the bathroom once R1 was done using the bathroom. When S1 returned, S1 found R1 sitting on the floor. S1 told S2, a medication technician, about R1's fall. S1 helped R1 back onto R1's wheelchair safely. S2 noted there was no injury to R1. S2 did not report R1's fall to S2's supervisors.

During visit, LPA Marrufo obtained copies of R1's Physician's Report and Appraisal/Needs and Services Plan. R1's Physician's Report states R1 is not able to care for R1's own toileting needs. The Background Information section of R1's Appraisal/Needs and Services Plan states, "[R1] requires the help of one person to complete activities of daily living." The Functional Skills section of R1's Appraisal/Needs and Services Plan states, "Resident requires full assistance with all functional mobility and activities of daily living (ADLs), including bathing, dressing, toileting, feeding, and ambulation, due to physical limitations. Dependent on staff for transfers, repositioning, and mobility."

See LIC809-C page for more information. Page 1 of 2.