Follow-up·February 5, 2024

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit to deliver findings from a completed case management investigation. LPA met with Manager Gabriela Zamora and explained the reason for this visit. During today's visit, LPA shared the investigation findings with the facility representativ e. The Department conducted an investigation after Licensee self-reported an incident which had occurred on 04/16/2022, in which Resident #1 (R1) jumped out of a second-story window at the facility. [See LIC 811 Confidential Names List for identification of R1.] The incident resulted in serious bodily injury to R1. CCLD initially had concerns regarding staff supervision. The Department's investigation involved multiple interviews with staff and outside sources, along with review of facility and medical records. The evidence showed: Prior to admission, R1 had been medically evaluated as stable and ready for discharge to an assisted living facility. R1 was ambulatory, independent with all activities of daily living, and able to communicate their needs. No additional care or supervision provisions were noted on written appraisal records. Staff had observed R1 approximately thirty minutes prior to the incident, and there were no indications that R1 was in distress or required assistance. Based on the preponderance of evidence obtained, the Department did not determine that there was a lack of staff supervision in regard to this incident. No deficiencies were issued during today's case management visit. An exit interview was conducted with Zamora, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit. Zamora's signature confirms receipt of these documents.