Facility Evaluation Report

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management Incident inspection at the facility today. The LPA met with Licensee representative Jovilito Gagarin and explained the reason for the inspection.

On 07/31/2025, Community Care Licensing (CCL) received an Unusual Incident/Injury Report (LIC 624) pertaining to Resident #1 (R1). The report stated that on 07/27/2025, about 4 pm, R1 while seated at the couch at the living room attempted to get up and fell on the floor on the right side of his body hitting the floor. A cut and bruise on the right elbow had resulted from that accident. Two staff (S1, S2) observed the incident. It was further reported that R1's responsible person was contacted the same day and notified of the incident. On, 07/29/25, R1's responsible party took R1 to the hospital and at the time of the report R1 was still at the hospital.

On 08/01/25, LPA Cortez conducted an interview with Licensee representative, Jovilito Gagarin telephonically , who stated they were informed from R1's responsible person that R1 had sustained a fracture. Additionally, Mr. Gagarin stated that R1 is a fall risk, and the week before R1 fell at the facility they had fallen at their responsible person home and believe the fracture was sustained from that fall.

During today's visit, the LPA conducted interviews with Licensee representative Jovilito Gagarin, two (2) staff, one (1) resident, and R1's responsible person (telephonically).

The report will continue on LIC809-C, 2nd page.