Incident investigation·September 22, 2023

Licensing Program Analysts (LPAs) Cassie Yang and Cheyenne Ratajczak arrived to the facility to conduct a case management visit regarding an incident report the Department received. LPAs met with Administrator, Aileen Fermo-Cantor, who arrived to the facility shortly after LPAs. LPAs and Administrator discussed the received special incident report regarding an incident that occurred on 9/20/2023 when R1 was hospitalized after R1 collapsed on the floor. Administrator provided LPAs time of when emergency medical services was contacted. LPAs and Administrator conducted a tour of R1's room, and additionally, LPAs conducted a review of R1's files. At this time, LPAs requested Administrator to submit a copy of LIC 500, R1's 2022-2023 Individual Program Plan, R1's Behavioral Intervention Progress Report, Physician's Report For Resident Care Facilities For the Elderly, Admission Agreement, R1's list of medication, R1's special incident report and R1's death report to be emailed to LPA Yang by close of business Friday 09/22/2023. LPA Yang offered to take R1's file to create copies as LPAs observed Administrator to be in distress but Administrator informed LPA she will do it as she is not aware Licensing Department can remove files from the facility. LPAs provided Administrator a copy of California Code Regulation 87506 Resident Records. Result of today's visit, no deficiencies cited as incident is under review. Exit interview, a copy of report was provided.