Incident investigation·June 23, 2022

At approximately 2:35PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, Melody Lee-Allmond. The purpose of this Case Management Visit is to follow up on multiple self-reported incident reports submitted to Community Care Licensing (CCL) by this facility. LPA discussed with Administrator an incident that occurred on 5/04/22. Report states that Resident 1 (R1) was observed by Medication Technician and Nurse to be unresponsive to verbal and physical stimuli. Facility called Emergency Personnel and notified R1's Responsible Party and Physician. Report states that R1 returned to facility on 5/06/22 with diagnosis of Urinary Tract Infection and was placed on Antibiotics. During intake of resident, Medication Technician observed bruising on R1. Facility notified Responsible Party and Physician of R1's return to community. Per conversation with Administrator, R1 was placed on alert charting after returning to community. Bruises were noted by facility. LPA discussed with Administrator an incident that occurred on 5/11/22. Report states that Resident 2 (R2) had a fall and complained of pain. Nurse was called to assess R2. Facility called Emergency Personnel and notified R2's Responsible Party and Physician. Community was notified by Emergency Room that R2 sustained a hairline fracture. Per conversation with Administrator, R2 is back in facility and was placed on alert charting. Responsible Party declined for R2 to receive surgery treatment for fracture. Continued on LIC 809-C Continued from LIC-809 LPA and Administrator discussed an SOC-341 that was submitted to CCL on 6/22/22. Report states that Staff observed R1 and R3 out on patio. Staff observed R3 to be agitated and pushed R1. R1 lost their balance and fell. Staff responded. R1 was observed to have mouth bleeding and complained of pain. Facility called Emergency Personnel and notified R1's Responsible Party and Physician. Report stated that R1 required surgery. Per conversation with Administrator, R3 is being assessed by their physician for new medication due to aggressive behaviors. Medical Personnel and Facility are discussing R1's discharge placement for Rehab. Administrator stated that Physician has been visiting frequently to address behaviors. No Deficiencies cited during this inspection. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.