Incident investigation·November 23, 2021

Licensing Program Analyst (LPA) Correia conducted an unannounced Case Management visit. LPA Correia met Medical Technician (Med-Tech) Lynn Ocenar at the front door, identified herself, and was granted entry into the facility. Med-Tech Ocenar notified Licensee Rayo, of the visit, who arrived at the facility and met with LPA Correia who disclosed the purpose of the visit. During today’s visit, LPA conducted a brief tour of the facility, obtained copies of resident records, and conducted staff interviews. The visit was initiated due to a self reported incident involving client #1, that occurred on November 17, 2021. The incident was reported to Community Care Licensing (CCL) via form LIC 624 – Unusual Incident/Injury Report, which was received in our office on November 19, 2021. Further Investigation is needed before determining findings. An exit interview was conducted with Licensee Rayo and a copy of this report, and Licensee Rights (LIC 9058 01/16) was provided via email. LPA requested an email read reply response from Licensee Rayo to confirm receipt of these rights.