Incident investigation·March 10, 2022

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit for the purpose of conducting a Case Management visit regarding an Unusual Incident Report (LIC 624) received from the facility on 03/09/2022. LPA was greeted at the reception desk by facility staff and explained the reason for the visit today. LPA met with the staff at Skilled Nursing Facility and she contacted via telephone, Assisted Living Administrator Claudia Lusca-Borcsa and informed her I was here. LPA Haley interviewed AD Lusca-Borcsa to follow up on the March 3rd incident regarding Resident 1 (R1). On 03/03/2022, R1 was found in in a sitting position bleeding profusely from the nose. A body assessment was done and noted R1 had an abrasion to the face, left cheek pain, and left eyebrow hematoma. First aid was applied and paramedics transferred R1 to West Anaheim Medical Center for evaluation. LPA Haley was provided copies of R1's: Admission Agreement, Face sheet, Incident Investigation Summary, Physician's Report, and Needs and Service plan. LPA explained if further follow up is required, LPA Haley will return at a later date and time for further information and details regarding this incident. No deficiencies cited at this time. An exit interview was conducted with Administrator Lusca-Borcsa and a copy of this report was provided.