complaint·July 21, 2021

On 07/22/21, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent complaint visit to deliver the findings of above allegation. LPA explained the reason for the visit with operations specialist/administrator. During investigation, R1 had an unwitnessed fall while in the TV room on 05/17/21 which resulted in five stitches to her left cheek. Prior to 05/17/21 incident, R1 also had another unwitnessed mechanical fall on 05/13/21 that resulted in a bruise to her right eye. In both instances, R1 was taken to the hospital for treatment/evaluation and released back to the facility with increased staff monitoring to reduce the chance of a fall. Interviews with staff confirm R1 is a fall risk, has an unsteady gait and often forgets to use her wheelchair to walk around due to dementia. Facility staff has communicated with R1’s family to hire a one on one caregiver to help supervise R1. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. No deficiencies cited during this visit. Exit Interview conducted and a copy of this report provided to operations specialist/administrator.