Incident investigation·April 1, 2022

Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains arrived at the facility and met with Administrator, Nicolasa Afable , to follow-up on an Unusual Incident Report (IR) received by the department on 3/29/2022. Facility currently does not have any COVID-19 positive cases. LPAs wore N-95 masks while in the facility. LPAs were screened by facility staff upon entry. IR received on 3/29/2022 stated that resident (R1) was transported to the hospital on 3/28/2022 due to an un-witnessed fall and AWOL incident from the same day . Per IR, R1 is in Mercy San Juan hospital in Sacramento and in a coma at this time. LPAs requested medical records for R1 from facility and administrator will send all required documents to department by 04/04/22 . At this time, this case management needs further investigation. Exit interview was conducted with Administrator . The signature of the Administrator on this acknowledges receipt of this document.