Incident investigation·May 23, 2022

Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management visit. LPA was greeted and identified herself to the receptionist. LPA then met and discussed the purpose of the visit with Sondra Brakeville, Executive Director. Today’s visit is regarding two self- reported incidents submitted to Community Care Licensing (CCL). The first incident involves Resident #1, (R1) (See LIC 811 Confidential Names List for identification of R1) falling and sustaining an injury on 5/7/22. R1 was transported to the hospital for evaluation. R1 returned to the facility on 5/8/22 and is receiving hospice services. The second incident involves Resident #2 (R2) (See LIC 811 Confidential Names List for identification of R2) sustaining an injury after falling in the bedroom on 5/13/22. R2 was transported to the hospital for evaluation. It was discovered at the hospital that R2 sustained an injury from the fall. LPA briefly toured the facility, interviewed staff, and reviewed records. No deficiencies observed during today’s visit. An exit interview was conducted with Jessica Swaaley, Business Office Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.