Incident investigation·September 22, 2022

Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced case management visit to follow up on an incident report dated 09/16/2022. LPA was greeted and granted entry into the facility and explained the reason for the visit to Caregiver, Gloria De Guzman. Danilo De Guzman, House Manager arrived 11:30 AM. Incident report indicated Resident 1 (R1) went to Kaiser due to slip and fall on 09/15/2022. Per interview with staff 1 (S1) was assisting R1 to bed, R1's legs gave out and R1 started to fall. S1 went to grab R1, but R1's elbow hit the floor. S1 called House Manager Danilo De Guzman over to the room. Danilo called 911 and paramedics assessed R1. R1 was then taken to hospital for further evaluation with Danilo De Guzman. Facility staff notified Administrator Teresa Alpuerto and R1's responsible party. R1 returned to facility the next morning with a diagnosis of a fractured upper arm. During the visit, LPA reviewed LIC 602, Individual Program Plan (IPP) and hospital discharge paperwork. No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.