Incident investigation·January 6, 2026

On January 6, 2026, Licensing Program Analyst (LPA) Murial Han conducted a Case Management visit to follow up on an incident that was reported by the facility. LPA met with the administrator and explained the purpose of today's visit. On December 15, 2025, the facility reported an incident that happened on December 12, 2025, concerning resident 1 (R1) who was complaining of having back pain and was diagnosed with compression fracture in the spine at the hospital. R1 returned to the facility on the same day. During today's visit, LPA observed R1 in the room on a recliner sofa and appeared to be comfortable. R1 did not remember going to the hospital but stated that he/she was comfortable and did not have any pain. R1 stated that everyone at the facility took well care of him/her. Based on the hospital records, R1 has a diagnosis that could have contributed to the compression fracture. LPA interviewed the administrator who stated that there were no incidents that happened in which could have resulted in the injury. The administrator stated that R1 is doing well and is being seen by the home health team. No deficiency is cited today. This report is reviewed and discussed with the administrator. A copy is provided.