Incident investigation·April 15, 2025

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Incident visit. LPA was greeted and allowed entry into the facility by staff, Khymberlie Talledo. LPA discussed the purpose of the visit with Staff, Roser Loja and Licensee, Sheikh Hafiz via telephone, while at the facility. During today's visit, LPA toured the facility, requested records, and interviewed staff and residents. The facility self reported an incident involving Resident #1 (R1). The report indicated on 02/17/25, a caregiver was assisting R1 with a brief change when R1 reported pain in their left leg. R1 was unable to turn over due to the pain. The facility contacted R1's responsible party to notify them of R1's condition. R1's responsible party arrived at the facility and transported R1 to the hospital. R1 was diagnosed at the hospital with a fracture in their upper femur, near the hip. Per the licensee, R1 received surgery and later returned to the facility. After returning to the facility, R1 was no longer eating and was placed on hospice. R1 passed away on 03/29/25, to an unrelated reason to the fracture. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Roser Loja whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]