Facility Evaluation Report

03/03/2026 10:20 AM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with administrator Esperanza Chavez. Today’s visit is regarding an incident that occurred on 02/19/2026 and was reported to licensing on 02/20/2026.

It was reported that on 02/19/2026 10:27 a.m. Staff observed C1 fall and hit the floor. Staff immediately assisted C1 by helping them sit up on the ground. While seated, staff noticed a visible bulge near C1’s shoulder, and their arm appeared to be hanging. C1 stated they could not move their arm and expressed pain. Staff immediately contacted C1’s house administrator and notified them of the incident and the need to call an ambulance due to the appearance of C1’s injury. House administrator stated they would meet the paramedics at the day program site. 10:45 a.m. – 911 was called and C1 was transported to the hospital for further medical evaluation and treatment. 12:00 p.m. The house administrator reported to the day program that C1 had a broken humerus bone.

During the course of the investigation, it was learned that C1 was wearing shoes that had very worn soles which could have contributed to the fall. LPA viewed photographs of the shoes that C1 was wearing the day of the fall and confirmed they were very worn. LPA viewed photographs that were taken directly after the fal lof the area of floor where C1 fell and it appeared to be dry. Administrator stated that no other clients fell at the day program on the day of C1’s fall. The day program had appropriate staffing ratios when the incident occurred.

No deficiencies were cited as a result of today’s visit. Exit interview conducted and a copy of the report was provided to administrator Esperanza Chavez.