Facility Evaluation Report

On this day, 12/12/24, at 5:45 p.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management in response to the Unusual Incident Report (UIR) and Death Report for resident (R1) submitted by Joseph Crisol, administrator (ADM). LPA met with Kenneth Lal, staff. LPA called and spoke over the phone with ADM and informed the reason for visit.

LPA requested for copies of LIC602A Physician's Report and LIC625 Appraisal/Needs and Services Plan. LPA conducted interviews.

Review of documents showed the following:

1. UIR: on 11/23/24, staff called licensee to report R1 has diarrhea and been going for 3 times in the last 3 hours. R1 was immediately brought to the hospital. R1 was admitted to the facility on 10/02/24.

2. Death Report: prior to R1's death, R1 was brought to the hospital on 11/23/24 for diarrhea where R1 was diagnosed with Clostridium Difficile Colitis (C. diff). R1 condition further deteriorated while at the hospital and passed away on 12/01/24. Certificate of Death showed C. diff as one of primary causes of death.

3. LIC602A Physician's Report dated 9/24/24: primary diagnosis - major neurocognitive disorder due to Alzheimer's with behavioral disturbance. R1 was dependent on others with all activities of daily living (ADLs).

Facility's Description of Operation/Program Plan does not include admitting and/or retaining resident with dementia/Alzheimer's. Facility does not have Dementia Care Plan