Facility Evaluation Report

On this day, May 21, 2026, at 11:45 am, 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 and received by LPA on May 18, 2026. LPA met with Maria Theresa "Tek" Ordiniza, assistant administrator, and informed the reason for visit.

Death Report indicated that on May 15, 2026, at around 5:00 pm, resident (R1) told staff that R1 is going for a walk which R1 normally does. Report further indicated that R1 is capable of going out in the community. At around 12:am , 2 sheriffs came and informed that they took R1 to the hospital, because R1 fell. At around 1:41 am, the ER nurse called and informed that R1 passed away due to 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 Record. LPA obtained copies of including but not limited to the following documents:

1. LIC601 Identification and Emergency Information

2. Most current Physician's Report with list of medications

5. LIC622 Centrally Stored Medication and Destruction Record.