Incident investigation·April 6, 2023

Licensing Program Analysts (LPAs) David Marrufo and Ravi Patel conducted an unannounced Case Management visit and met with Valerie Alves, Care Center Administrator. The purpose of the visit was to respond to a Death Report and Incident Report regarding resident R1 falling on a treadmill in the facility on 03/25/2023 and passing away on 03/29/2023. During visit, LPAs obtained copies of R1's Admission Agreement and Emergency Contact Face Sheet. LPA's reviewed R1's resident records and did not observe any documents indicating assisted living services were provided to R1 or that R1 needed supervision. LPA's obtained a copy of R1's Fitness Center Release and Waiver form which R1 signed on 08/25/2015. LPAs discussed with Mark Nelson, Associate Executive Director of Independent Living, about the facility's plan to remind resident about proper use of exercise equipment. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Valerie Alves, Care Center Administrator, and a copy of the report was provided.