Follow-up·December 28, 2023

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit regarding an incident report. LPA met with Administrator, Donna Lagman and explained the purpose of the visit. On December 27, 2023, the Department received an in incident report stating resident, R1 had a fall and was transported to the hospital via 911. R1 was in the Intensive Care Unit to monitor breathing and pain. During visit, LPA Rai interview ADM, ADM stated R1 had an unwitnessed fall on 12/26/2023 at approximately 3am when S1 and S2 found R1 on the floor of R1's room. R1 complained of back pain but refused to go to the hospital. At approximately 7am, S1 and S2 check on R1 and decided to send R1 to the hospital via 911/ paramedics. LPA interviewed 2 staff (S1 and S2). LPA requested R1's Progress Notes which were documented starting 6/15/2023 and ending 9/3/2023, R1's Identification and Emergency Information, R1's After Discharge Summary 5/12/2023, R1's Appraisal and staff training pertaining to but not limited to observation of resident and emergency protocols. This case management will be kept open pending investigation. Exit interview was conducted with Administrator, Donna Lagman. A copy of this report was provided to Program Manager, Administrator, Donna Lagman.