Incident investigation·October 20, 2025

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit regarding a self-reported incident. LPA was greeted by, identified herself to, and explained the purpose of the visit with Executive Director Jill McDonald. On 10/17/2025, the Department received a self-reported incident report from the licensee that described an incident that occurred between Resident 1 and Staff 1. [Executive Director was provided with LIC811 Confidential Names List to identify individuals] During today’s visit, LPA conducted a health and safety check, observed residents in care, and reviewed facility records. No deficiencies were cited on today’s date. An exit interview was conducted with Executive Director Jill McDonald, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).