Incident investigation·December 15, 2021

Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced Case Management visit to follow up on an Incident report submitted to Community Care Licensing on 12/14/2021. LPA Martinez was greeted and granted entry into the facility by Administrator Edward Maslobodsky and explained the reason for the visit. Incident report dated 12/14/2021 indicated that Resident 1 (R1) complained of lower back pain and it was getting uncomfortable. R1 requested to go to the hospital and was transported to Huntington Beach Hospital for evaluation. AD received a call from the hospital that R1 will be transferred to UCI Medical Center and told AD that R1 had fallen at the facility. AD stated he told hospital staff that R1 never reported the fall and only reported to having lower back pain, therefore Lynch Ambulance was called to transport. LPA Martinez toured R1's room and did not observe any health and safety concerns in the room. Per Physician's Report dated 03/20/2018, R1 is diagnosed with Schizophrenia. R1 was admitted into the facility on 12/8/2015. No deficiency cited during this review as per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted with AD Maslobodsky and a copy of this report will be emailed.