Incident investigation·July 13, 2021

Licensing Program Analyst (LPA) Konnor Leitzell arrived at facility to conduct a Case Management Visit. Community Care Licensing (CCL) received an Incident Report (LIC 624) and Report or Suspected Dependent Adult/Elder Abuse (SOC 341) from facility regarding R1's attempted suicide. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon entry, LPA was screened by Staff and was greeted by Cheryl Martin (Admin). LPA then explained the purpose for the visit to admin. During the Case Management Visit, LPA conducted interviews with Admin, S1, and R1; as well as reviewed R1’s Physician’s Report (LIC 602) and Charting Notes for the last two (2) weeks. Admin is to send LPA the weekly “check-in” notes by COB 7/16/2021. No deficiencies are being cited as a result of today’s visit. Exit interview conducted and report left at facility.