Incident investigation·October 4, 2024

Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to conduct a required annual inspection and in conjunction initiate this case management visit. LPA Lopez identified herself and was granted entry by Assistant Administrator Richard Tibi. LPA Lopez stated the purpose of the visit and reviewed the basic elements of the visit with Assistant Administrator Tibi. This visit was in response to an Unusual Incident/Injury Report (IR) that was received at the San Diego Regional Office on Wednesday, September 18, 2024. The IR stated that there was an incident that transpired on Saturday, September 14, 2024, with resident #1 (R1) who was transported to the hospital due to becoming weak. The facility notified the resident’s primary care physician (PCP) and their power of attorney (POA). During today's visit LPA Lopez toured the facility, spoke with staff, and requested and obtained relevant documents pertinent to this incident. LPA Lopez verified R1 was still in the hospital and was to return to the facility within the next two weeks. Staff said that they contacted the POA to notify them of the residents condition and they agreed to contact emergency personnel to have the resident transported to the hospital due to changes in their condition. According to records R1 had gone to the hospital days prior due to refusing meals. No deficiencies were cited during today’s visit. An exit interview was conducted with Assistant Administrator Tibi, and a copy of this report, LIC811 and Licensee Appeal Rights (LIC9058) were provided at the conclusion of the visit. The signature below confirms that the documents were received.