Incident investigation·May 1, 2024

On 05/01/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Case Management Incident visit. LPA met with caregiver, Avonett John, and explained the purpose of the visit. LPA requested for caregiver to notify Administrator, Ruby Liu, of LPA's presence at the facility. Administrator was unable to meet at the facility and gave caregiver permission to assist LPA during today's visit. The purpose of the visit is to gather additional information regarding an unusual incident/injury report that was sent to Community Care Licensing (CCL) on 04/25/2024. The report indicates that Resident #1 (R1) had a fall sustaining injury which resulted in R1 having surgery. During today’s visit LPA obtained a copy of R1s file and conducted an interview with administrator via phone call. LPA also interviewed Staff #1 (S1) and Resident #2 (R2) who were present during the time of R1s fall. R1 is currently still out of the facility. At this time, deficiencies are not being cited. An exit interview conducted and copy of the report was left at the facility.