Incident investigation·December 14, 2021

Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Case Management - Incident inspection pertaining to a self reported Unusual Incident/Injury Report (LIC 624) received on 12/13/2021. The LPA met with Memory Care Director Yasmin Hernandez at 11:32 AM as the Executive Director Michele Johnson was in a meeting. The self reported Unusual Incident/Injury Report (LIC 624) pertains to an incident that occurred on 11/29/2021 regarding Resident #1 (R1). During today's inspection, the LPA conducted interviews with Memory Care Director Yasmin Hernandez, two facility staff, and Resident #2 (R2) between 11:47 AM and 12:42 PM. The LPA reviewed facility records and obtained copies of pertinent records. At 1:10 PM, the LPA reviewed the video footage of the lobby area with Executive Director Michele Johnson and obtained a copy of the requested footage. No immediate health and safety concerns were observed during today's inspection. The LPA has determined further investigation is needed. The report was reviewed with Executive Director Michele Johnson. A copy of the report will be emailed.