Facility Evaluation Report

On 04/13/2023 at 4:40 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management in response to the Death Report submitted by the facility to the Department. LPA met with staff, Rolando Galang and Marieta Balilo. LPA called and spoke over the phone with Maria Theresa "Tek" Ordiniza, assistant administrator, who arrived after several minutes. LPA informed the reason for visit.

Death Report indicated that on 04/10/2023 at a little over 4:00 am, staff saw resident (R1) walking around his room and seemed restless. Staff asked R1 and R1 tried to answer but seemed like R1 was having hard time breathing. Staff called 911 right away. R1 was taken to the hospital where R1 passed away. Report indicated the per attending nurse, R1 passed away of cardiac arrest.

LPA conducted interviews, and reviewed R1's records. LPA also reviewed doctor's order of medications and remaining medications on facility's hand and compared with Medication Administration Records. LPA obtained copies of the following documents

1. LIC601 Identification and Emergency Information

Exit interview conducted and copy of this report provided.