Incident investigation·April 21, 2023

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to an incident that occurred on 4/15/23 between residents (R1 and R2). LPA received an incident report dated 4/17/23 for the incident. LPA attempted to speak to resident (R1) in the presence of Administrator, but resident was not able to be understood but was in a pleasant mood. LPA did not observe R1 to show any bruises on her face or lower legs that were not covered by clothing. R1 was sitting in a wheelchair next to one of the glass exit doors, enjoying the outside view and/or sun. LPA observed R1 able to move herself in a wheelchair and Administrator confirmed that R1 is able to self ambulate in her wheelchair. Administrator stated that resident (R2) who was involved in the incident was taken to the emergency room for a mental evaluation on 4/15/23 and will not be returning to the facility due to changes in behavior from a recent stroke. Administrator confirmed that the Ombudsman's office was at the facility earlier this week also to follow up on the incident reported. There are no deficiencies issued on this report. Exit interview. Copy of report provided to Administrator.