Incident investigation·September 18, 2024

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to conduct follow up regarding a self-reported incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Marilyn Escolastico. Administrator Julia Goker arrived during the visit. On 9/16/2024, the Department received an incident report from the facility which stated that on 9/15/2024, Resident 1 (R1) had an unwitnessed fall during the night. [Administrator was provided with an LIC811 Confidential Names List to identify R1] Staff assisted R1 back into bed. The incident report noted that R1 had complaints of rib pain. Facility staff notified the Administrator and R1's responsible party. The following day on 9/16/2024, R1 was transported to the hospital by R1's responsible party and it was determined that R1 had sustained injuries. R1 received medical treatment and returned to the facility on the same day. During today’s visit, LPA conducted a health and safety check, toured the facility, observed residents in care, including R1, and reviewed and obtained copies of facility records. No deficiencies were cited on today’s date. An exit interview was conducted with Administrator Julia Goker, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).