Incident investigation·April 23, 2025

LPA Johnson arrived to the facility unannounced to conduct a case management incident report submitted to the department on 4/14/2025. It was reported to the department that at around 1:00 AM, 4/12/2025, resident reported he was trying to use his urinal and slipped out of his chair. Per resident, he hit his head on the dresser and landed on the floor, No reported dizziness, no noted injuries or bruising, Resident had complaint of mild pain to his head, Paramedics were called and transported resident to San Joaquin General Hospital. LPA reviewed resident's file and reviewed pertinent documentation related to admissions to this facility. As a result of this incident the resident was sent out on 4/12/2025 and has not returned. The facility will reassess R1 before he returns. LPA was able to obtained copies of resident's discharge summary from the skilled NF, functional assessment, service plan and other pertinent information from R1's file. No deficiencies were cited on today's visit Exit interview conducted.