Incident investigation·December 27, 2022

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit for the purpose of conducting a Case Management visit regarding Unusual Incident Reports (LIC 624) sent to the regional office. Both incident report were received December 16, 2022. LPA interviewed Wellness Coordinator Alexsondra Carrillo and spoke with Administrator (AD) Glen Goldsmith via telephone regarding the incident reports. Regarding the first LIC 624 (incident date 12.14.22) LPA Haley received a copy of Resident 1's (R1) physicians report, and the information on R1's new dialysis center and the information the new transportation company taking R1 to his dialysis appointments. Regarding the second incident report (incident date 12.11.22) LPA Haley received copies of Resident 2s (R2): basic fact sheet, physicians report, and preplacement appraisal information. Further, LPA Haley reviewed the file for Staff 1 (S1) and received copies of the LIC 501 and a copy of Relias training completed by S1. No deficiencies are being cited as a result of today's visit. An exit interview was conducted and a copy of this report was provided.