Incident investigation·February 3, 2023

At approximately 12:15PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Incident visit and met with Executive Director, Angela Boucher-Turin. The purpose of the visit was to follow up on three self reported incidents submitted to Community Care Licensing (CCL). LPA and Executive Director discussed the following reports: Incident Report 1: CCL received an incident report on 12/15/2022. Incident report states that on 12/12/2022 Resident 1 (R1) was observed on the floor by care staff. R1 obtained a large laceration to their right leg. Facility contacted Emergency Personnel to evaluate and resident was taken to the hospital. Facility made all appropriate notifications per regulation. On 12/15/2022, LPA and Executive Director discussed R1's plan of care upon their return to facility. As of 2/3/2023, R1 has been observed to be doing well. Incident Report 2: CCL received an incident report on 11/15/2022. Incident report states that on 11/4/2022, Resident 2 (R2) was observed to be hallucinating and had high blood pressure. Facility contacted Emergency Personnel to evaluate and R2 was taken to the hospital. R2 was diagnosed with pneumonia and sepsis. R2 was sent to a Skilled Nursing Facility. Facility made all appropriate notifications per regulation. LPA and Executive Director discussed R2. Per conversation, R2 did not present with any symptoms related to sepsis prior to being sent out to the hospital. As of 2/3/2023, R2 has made arrangements to move out due to changing care needs. Continued on LIC-809C Continued from LIC-809 Incident Report 3: CCL received an incident report on 1/23/2023. Incident report states that on 1/21/2023, Resident 3 (R3) was observed on the floor by care staff. Resident stated they had been drinking that day and denied having pain or injuries. Resident was later found on the floor again by care staff with an empty bottle of alcohol. Facility contacted Emergency Personnel to evaluate and R3 was sent to the hospital. Facility made all appropriate notifications per regulation. LPA and Executive Director discussed R3. As of 2/3/2023, Facility has been in contact with R3's Physician and Responsible Party regarding R3 and their care needs. Facility is monitoring R3 appropriately. LPA conducted a walkthrough of the facility with Executive Director and discussed the following: Covid and Influenza A Protocols Staffing Incident Reports Training Annual Inspections No Deficiencies cited during visit. Exit interview conducted. Copy of report and LIC 811 (Confidential Names) discussed and provided to Administrator. Signature on form confirms receipt of documents.