Incident investigation·April 9, 2025

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management visit. The LPA introduced herself and disclosed the purpose to Executive Director Brandon Cho. Today's visit was in response to an Incident Report submitted to the Department for Resident 1 (R1). Per facility reporting, R1 sustained a fall on 3/27/2025, which resulted in a femoral neck fracture. Reports indicate R1 was transported to the hospital and underwent surgery. Per Administrator Cho, R1 was transferred to a rehabilitation facility after hospitalization and will not be returning the the facility due to R1's need for a high level of care LPA conducted a review of R1's pertinent records and interviewed staff. No health and safety concerns were identified and no deficiencies were cited during today's visit. An exit interview was conducted with Administrator Cho, to whom a copy of this report, and the Licensee Appeal Rights (LIC 9058 03/22) were provided.