Incident investigation·April 7, 2021

Licensing Program Analyst (LPA), Kristina Ryan, conducted an unannounced case management virtual visit, due to the COVID-19 pandemic. LPA identified herself and stated the purpose of the visit to CEO, Pam Ferris` The facility self-reported an incident regarding Resident 1 (R1) to Community Care Licensing on March 23, 2021. The incident report stated that on March 19 2021, R1 was found with an injury. On today’s date, LPA toured the facility, requested copies of additional facility records and interviewed staff. No deficiencies were cited at this time. An exit interview was conducted with CEO, Pam Ferris, to whom a copy of this report, LIC811 Confidential Names list, and the Licensee/Appeal Rights (9058 01/16) were provided via e-mail. An electronic read receipt verifies receipt of these documents.