Incident investigation·November 25, 2025

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 11/25/25 to conduct a case management inspection to follow up on a choking incident on 11/10/25 and 11/12/25 for resident, R1 at the facility. LPA met with Staff, LVN Eva Bowlin and explained the purpose of the visit. Facility submitted incident report (LIC624) to department on 11/17/25 about resident, R1 who had choking incident on 11/10/25 during outing (1st incident ) and 11/12/25 (2nd incident) in the main dining room around 10.00am. On 11/10/25, R1 choked on candy while in store and facility staff called emergency services (9-1-1) for R1 when R1 returned from outing and R1 was sent to local hospital to get medical assistance. On 11/12/25, R1 choked at facility in the dining room. Facility staff took appropriate measures and performed Heimlich Maneuver on R1. Medical assistance was offered but declined by R1 due to this incident on 11/12/25. R1 was back to their baseline after this incident. Facility notified R1s family, physician and other required agencies as required. During today visit, LPA interviewed R1 and staff. After reviewing the incidents reports and information gathered, it has been determined that facility took appropriate measures to address R1s choking incidents . No citations were observed or cited per Title 22 Regulations. Exit interview conducted and copy of the report has been provided.