Incident investigation·August 18, 2023

Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to the facility. LPA introduced herself, was granted entry into the facility, and met with Stephanie Boudreau, Executive Director, and Sheila Caldito, Wellness Center Manager, to whom she disclosed the purpose of the visit. The visit was initiated in response to a self-reported incident involving Resident #1 (R1) [LIC 811 Confidential Names List was provided to identify the resident] that occurred on August 12, 2023. The Licensee's authorized representative self-reported the incident by submitting a Special Incident Report and an SOC 341 - Report of Suspected Dependent Adult/Elder Abuse to Community Care Licensing (CCL), which were received by CCL on August 16, 2023. During today's visit, LPA toured the facility, obtained copies of resident records, and observed residents in care. No immediate health and/or safety concerns were observed. No deficiencies were cited during today's visit. This report was reviewed with Stephanie Boudreau, and copies of the report and Licensee/Appeal Rights were provided to the Executive Director at the conclusion of the visit. Her signature on this form acknowledges receipt of the rights and a copy of the report.