Incident investigation·July 13, 2022

This is an amendment to the original 809 issued on 7/13/2022. On 07/13/2022 at 9:50 AM Licensing Program Analysts (LPAs) C. Fowler and L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 07/10/2022. LPA met with Administrator Dolly Rizvi and explained the purpose of the visit. Incident report dated 7/10/2022 revealed Resident 1 (R1) jumped from the 3rd floor of the facility. During visit LPAs interviewed ED Dolly Rizvi, S2. S3, collected and reviewed documents, and toured four (4) rooms in memory care. During interview ED Dolly Rizvi stated she conducted an over-the-phone assessment with Kaiser prior to R1 being admitted into the facility on 07/08/2022. ED Dolly Rizvi stated she was not aware that R1 had suicidal ideations. Further investigation needed. Exit interview conducted and a copy of this report was provided.