Incident investigation·March 13, 2025

On March 13, 2025 Licensing Program Analyst Rachel Bruce arrived to conduct an unannounced Case Management visit. LPA arrived, introduced self, stated purpose of visit, and allowed entrance into facility by Program Manager, Corina Garcia. Administrator(AD), Noemi Gallo was called and arrived shortly thereafter to meet with LPA On January 18, 2025 CCL received an incident report noting that R1 had undone the seat belt of her wheelchair and fell. LPA discussed the incident with AD and ascertained that the resident's medical file contained documentation that the doctor ordered a wheelchair with a seat belt. The family was aware as well as the resident. Staff monitors the resident but in the situation above the resident chose not to wait for assistance in getting a cup of coffee and ultimately had a fall as a result. No citations issued at today's visit.