Incident investigation·September 11, 2025

On 09/11/2025 at 9:00 AM, Licensing Program Analysts (LPAs) P.Manalo and K.Nguyen conducted an unannounced Case Management visit regarding a self-reported incident that occured on 08/04/2025. Administrator self-reported the incident on 08/04/2025. LPA met with Administrator, Divine Fernandez, and explained the purpose of the visit. LPAs received a self-reported incident report from the facility that indicated that Resident 1 (R1) and Resident 2 (R2) had an altercation where R1 was attempting to grab R2's food. Interview with Administrator revealed that an internal investigation was conducted regarding the incident and facility has been in contact with R1's responsible party regarding R1's care. LPAs interviewed Staff 1 (1) in which S1 stated that there has been no other altercation with R1 since then and R1 has a 1:1 private caregiver for two hours a day. LPAs is requesting for the facility to submit an updated appraisal needs and services plan and care plan for R1 by 09/25/2025 for review. No deficiency noted. Exit interview conducted and a copy of this report was provided.