Facility Evaluation Report

On this day, 1/17/25, while at the facility for other reason, Aidan Castrence, administrator (ADM), informed Licensing Program Analyst (LPA) Delmundo that resident (R1) passed away this morning at around 6:30 a.m. ADM stated that 9-1-1 was called and the first responders pronounced R1 dead at around 6:30 a.m. ADM stated that Adelaide Castrence, license, and R1's mother came. R1's body was picked-up by the mortuary. ADM stated he will send to LPA the Death Report, and that he can not come to the facility to meet LPA and authorized Janae Oltmans, assistant to the administrator, to sign and receive this report.

On this same day, LPA reviewed R1's file, doctor's order of medications, checked the medications and compared with Medication Administration Records (MAR). LPA conducted interviews and obtained copies of R1's following documents: LIC601 Identification and Emergency Contact Information; Face Sheet; LIC602 Physician's Report; LIC625 Appraisal/Needs and Services Plan; list of medications; MAR; facility notes

Exit interview conducted and copy of this report provided.