Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Case Management – Incident visit for the purpose of following up on a self-reported incident report verbally reported to LPA on 04/01/2022, and written report on 04/05/2022. LPA met with Administrator Martha Berard and explained the reason for today's visit. Entrance interview conducted.

On 04/01/2022 at 3:52PM, LPA received a phone call from Administrator Martha Berard reporting a possible incident involving two facility residents that occurred on 03/31/2022 around 7:47PM. LPA requested pertinent documents be sent to the LPA, along with a written incident report. The Woodland Hills Adult and Senior Care Regional Office (RO) received the written incident report and supporting documentation via fax on 04/05/2022.

During today's visit, LPA toured the facility with Business Office Director Kailey Vanderwall at 1:35PM, and interviewed residents from 1:49PM - 2:57PM. No immediate health and safety concerns were observed during today's visit.

LPA has determined further investigation is needed. The LPA will return at a later date to continue the investigation.

Due to technical difficulties, exit interview was conducted via telephone with Administrator Martha Berard at 5:24PM. Report was issued via email for signature.