Incident investigation·July 11, 2022

On 07/11/22 at 11:55 AM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving self-report SOC341 dated 06/03/22 and incident dated 6/27/22 submitted to CCLD. LPA explained the purpose of the visit with Executive Director (ED). Self-report SOC341 regarding physical interaction between 2 residents. Based on record review and interview, both subjected residents (R1 & R2) are in memory care unit, they were separated and redirected away in time manor, and monitored by staff frequently. No injury was observed to both residents after incident occurred. Residents' physician, responsible party and ombudsman were notified. Similar incidents have not been repeated since then. Self-report incident regarding resident developed wound while in care. Based on record review and interview, a assigned wound care nurse has been monitoring and caring resident R3's wound. When R3's wound was noticed getting worse, R3 was transported to Skill Nursing Facility for wound treatment and has not returned to facility as of the date of LPA visit. LPA obtained residents' physician's reports, care notes, and needs and services plans during visit. Exit interview conducted with ED, and a copy of this report provided.