Incident investigation·April 11, 2025

Licensing Program Analyst (LPA) De Leon conducted a Case Management Incident Visit to the facility above. LPA met with Jessica Bailey and explained the purpose of the visit. Administrator called in incident report immediately to LPA on 04/10/2025 and will follow up with written incident report. The incident was cross reported to the Long Term Care Ombudsman (LTCO) office and law enforcement. LPA De Leon requested the following records: Resident 1 (R1) Incident Report LIC. 602A Physicians report, Appraisal Needs and Services Plan, Medication List and emergency ID and contact form. LPA De Leon conducted interview with staff caregivers, Administrator and resident. LPA may return at a later date if citations are warranted. Exit interview conducted and copy of report printed for Administrator.