Facility Evaluation Report

On this day, 12/15/2023, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct case management as a follow-up on the Death Report received by the Department on 12/11/23. Report indicated that when caregiver (S1) arrived at R1's apartment to assist with feeding for dinner, S1 noted that R1 was unresponsive. Med-tech (S2) was gathering vital signs and noted that there was no pulse noted. Wellness Nurse (S3) called 9-1-1 and called the closest kin. Report also indicated that R1 returned to the facility on 12/08/23 from post acute.

LPA obtained copies of including but not limited to the following documents: Notice of Transfer/Discharge from post acute; LIC602A Physician's Report; LIC9172 Functional Capability Assessment dated 12/08/23; Progress Notes, LPA conducted interviews.

Exit interview conducted and copy of this report provided.