Incident investigation·September 8, 2021

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management- Incident visit. LPA met with Administrator, Alison Humora and discussed the purpose of the visit. During today's visit, LPA briefly toured the facility, requested records and interviewed staff and residents. On 08/30/21, Community Care Licensing received a self reported incident involving Resident #1 (R1) and Staff #1 (S1). The alleged incident occurred on 08/23/21 at the facility. The incident report stated S1 was ringing out a towel and hit R1 with the towel, no injury was sustained. No deficiencies were issued. An exit interview was conducted with Administrator and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic read receipt confirmation was requested to be sent by the Administrator upon receipt of the documents.