Incident investigation·January 18, 2023

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced Case Management visit. The LPA introduced himself and disclosed the purpose to Executive Director, Mark Alsop, and Program Director, Denise Notter. Today's visit was in response to an Incident Report and a Death Certificate that was submitted to the Department, for Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1]. R1 sustained a fall on 12/12/2022, was transported to the hospital and passed away on 12/17/2022. The LPA conducted a tour of the facility and secured pertinent records. No health and safety concerns were identified and no deficiencies were cited during today's visit. An exit interview was conducted with Executive Director, Mark Alsop, to whom a copy of this report and appeal rights (LIC9058 03/22) were provided via electronic mail. An electronic mail read receipt confirms these documents were received.