Incident investigation·May 7, 2024

Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to initiate a case management investigation. LPA Lopez identified herself and was granted entry by concierge Caroline Fitzgerald. LPA Lopez stated the purpose of the visit and reviewed the basic elements of the visit with Executive Director Marivel Johnson. This visit was in response to an Unusual Incident/Injury Report (IR) that was received at the San Diego Regional Office on Monday, May 6, 2024. The IR said that there was an incident that had transpired on Tuesday, April 30, 2024, with resident #1 (R1) who sustained injuries. During today's visit LPA Lopez spoke with staff and requested and obtained relevant documents pertinent to this incident. LPA Lopez verified the facility staff who found resident and made contact with their nurses. The facility staff who arrived at the scene contacted the nurse who then called paramedics who transported the resident to the hospital where resident was seen. LPA informed Executive Director Marivel Johnson that there may be further follow-up telephone calls or visits for this incident. LPA requested for Executive Director Johnson to submit a death certificate upon receipt to LPA Lopez. An exit interview was conducted with Executive Director Marivel Johnson, and a copy of this report, LIC811 and Licensee Appeal Rights (LIC9058) were provided to ED Johnson at the conclusion of the visit. The signature below confirms that the documents were received.