Incident investigation·December 16, 2021

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Ruth Martinez to follow up on an incident reported to Community Care Licensing. LPA arrived at facility was greeted at the door by caregiver and granted entry. LPA met with Jennifer Suckiel , administrator and explained the purpose of today’s visit. Incidents were self reported on 12/07/2021 regarding R1’s incidents on 12/01/2021. On 12/01/2021 R1 was in the 3 rd floor hallway and did not have a cane for assistance. R1 had forgotten to bring the cane and had an unwitnessed fall. R1 is an independent living resident and does not have a history of falls. EMS was activated and EMT on duty responded to call and immediately performed first aid. Facility immediately called 911 and paramedics arrived to evaluate R1. Resident was transported to hospital for evaluation. All responsible parties were notified and R1 returned to the community. R1 to follow up with primary physician. LPA found that facility acted appropriately and in a timely manner to address the incident and all other immediate attention to injuries in question. LPA did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations . This report was reviewed with Jennifer Suckiel , Administrator and a copy of this report was provided and left at the facility.