Incident investigation·September 16, 2025

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a case management visit. LPA was granted entry into the facility by staff and explained the reason for the visit. The Department received an Unusual Incident/Injury Report on 09/12/2025 for an incident that occurred with Resident 1 (R1) on 09/10/2025. LPA Mendivil obtained copies of LIC 602 and Care Plan via email on 09/12/2025. While at the facility LPA Mendivil requested copies of admission agreement, medication administration records for R1, care notes and staff schedule to be emailed to LPA by COB 09/16/2025. LPA toured common areas of the facility. LPA observed Assisted Living residents participating in chair volleyball and Memory Care residents were in the common area watching a movie. LPA did not observe any immediate health and safety concerns during today’s visit. No deficiencies cited at this time. An exit interview was conducted and a copy of this report was provided.