Incident investigation·March 29, 2024

Licensing Program Analyst (LPA) Daniel Pena, conducted an unannounced Case Management Visit.  LPA was greeted by and met with Executive Director, LaTressa Downing to discuss the purpose of the visit. Today's visit is in response to the self reported incident of Resident 1 (R1) who sustained an unwitnessed injury on 3/21/2024. Per reporting, interviews with R1 and record review, staff was alerted by R1 of a deep wound below the occipital region. 911 was called and R1 was transported to the hospital for evaluation and treatment. LPA conducted interviews with R1 and staff and collected records. LPA also conducted a health and safety check. Interviews revealed R1 received four (4) staples to close the wound. The facility has arranged for a mobile physician to remove the staples on 3/30/2024. LPA observed no health or safety issues. No deficiencies were cited during today's visit. An exit interview was conducted with Director, Downing, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22).  Ms. Downing's signature confirms receipt of these documents.