Incident investigation·August 31, 2022

Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management visit to follow up on an incident report received by Community Care Licensing on 7/25/22. LPA Williamson identified herself and was granted entry into the facility by Caregiver Victoria Bozzo. LPA met with Administrators Debra Bunnell and Nora Garcia, and discussed the purpose of the visit. R1 On 7/25/22, the facility submitted a self- reported incident. It was reported that a resident had an un-witnessed fall. Resident 1 (R1) (See LIC 811 Confidential Names List to identify ) was found on the floor in the hallway of the facility in front of their wheelchair covered in feces. R1 was assisted by Caregiver Victoria Bozzo and returned back to the wheelchair, assessed for injuries and cleaned up in the shower. While seated in the shower chair, R1 slid forward in the wheelchair and leaned to far and bumped their head on the shower wall. R1 denied hitting their head and being in pain. Caregiver heard R1's head hit the shower wall. Caregiver contacted 911, however when they arrived R1 refused to leave with the paramedics. R1 was assessed by the paramedics and there, were no injuries or concerns. R1 is ambulatory, however uses a wheelchair and requires the assistance of one caregiver for Activities of Daily Living (ADLs). R1's responsible party was notified. During today’s visit, LPA briefly toured the facility, conducted staff interviews, reviewed resident records. No deficiencies were cited during today’s visit. An exit interview was conducted with Debra Bunnell, Administrator and Nora Garcia, Administrator a copy of this report, LIC 811 and Licensee/Appeal Rights (LIC 9058 01/16) was provided to Administrators.