Incident investigation·May 29, 2024

Licensing Program Analysts (LPA) Talwinder Bains arrived at the facility unannounced on 05/29/24 to do case management visit . LPA met with Assistant Director,Tosha Devi and explained the purpose of the visit. Department followed up on Incident Report sent by facility on 05/24/24 for date -05/24/24 regarding resident, R1 where R1 alleged that they fell in the transportation vehicle ( a non -medical ambulance) during a medical appointment on 05/24/24 when they returned around 1pm and refused to come out from vehicle . Facility Directors and staff members assessed R1 and suggested ER visit for possible injuries. R1 stated that they had some discomfort and pain on their left hip and right elbow. Facility Director contacted and spoke to the transportation company owner, they stated all transportation vehicles have a camera, and they have reviewed the footage and no fall occurred during this visit. Facility directors and staff contacted Alpha one ambulance to have the resident, R1 assessed for injuries, but R1 refused and signed AMA to be seen in the ER department. Staff checked R1 for any possible injuries, but none were observed. Facility notified R1s physician, responsible party, and long-term care ombudsman (LTCO) regarding this incident. Department conducted interview with resident, R1 regarding this incident during today’s visit. LPA requested documents related to this incident and facility will submit all documents by 05/31/24 by 5pm. At this time, this case in under review and department will do follow up as needed. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.