Incident investigation·March 28, 2025

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Case Management inspection and was greeted by Administrator, Wendy Cornejo. On 3/17/25 CCL received SOC341 from facility reporting suspected abuse of resident (R1). SOC341 indicates R1 is a resident of the Memory Care unit at facility. SOC341 indicates that on 3/15/25 outside agency caregiver (I1) was assisting R1 to their apartment. R1 was resistant to entering their room, so I1 grabbed R1 by the wrist and pulled R1 into their apartment. R1 was pulled such that they lost their footing/balance and hit their head on the closet door knob as well as their left shoulder as they fell to the floor. I1 did not call for help and did not assist R1 up from the floor. I1 then proceeded to lock the apartment door and move about the apartment shutting blinds and adjusting the bedding. R1 remained on the floor until Cogir caregiver (S1) entered the room. S1 immediately performed injury assessment and wellness check on resident. After no injuries were assessed, S1 then helped R1 up with the assistance of I1. Written statement of S1's account of the incident was submitted to CCL at time of SOC341 submission. S1 states that upon entering R1's apartment she found R1 on the floor. S1 asked I1 what happened. I1 reported to S1 that R1 had become tired and needed to sit down, so I1 pulled the ottoman over for R1 to sit on, but R1 "kind of rolled off" the ottoman, which is why R1 was now on the floor. S1 then assisted R1 up off the floor and proceeded to help R1 with toileting needs before helping R1 in bed to rest. During visit, LPA interviewed Health and Wellness Director (HWD), Alexandra (Alyx) Fischer. LPA viewed Continued on 809C... Continued from 809... video record evidence of incident. LPA requested video record be submitted to CCL. Record release requires CDSS written request to be submitted by Licensing Program Manager (LPM). LPA will submit LPM written request to facility once obtained. LPA asked HWD if S1 would be willing to sign and date their written statement that was submitted with SOC341. S1 was not present at facility during LPA visit so HWD will ask S1 and forward to CCL if S1 agrees to sign and date their statement. LPA requested HWD complete a LIC855 Declaration, documenting her accounting of Cogir response to incident and any applicable or additional information has about the incident and I1. HWD will check with corporate Cogir contact as to corporate policy around providing LIC855 Declaration to CCL. HWD will submit LIC855 if/when corporate gives their approval. Exit interview conducted with HWD and a copy of this report given. No deficiencies cited.