Facility Evaluation Report

Licensing Program Analyst (LPA) Delmundo conducted an unannounced case management visit pertaining to incidents and death report submitted to Community Care Licensing by the facility. LPA met with staff, Aileen Fajardo, and informed the purpose of visit. LPA called and with spoke Juliana Taburaza, licensee, administrator, over the phone, who arrived with Sheila Muniz, administrator, after several minutes.

Special Incident Reports (SIRs) indicated the following:

1 June 15, 2022: at 7:00 am, resident (R1) pointed her stomach to the staff. Staff assisted R1 to the toilet. When staff assisted R1 to stand up to take a shower, R1 vomited but nothing came out and R1 appeared pale and weak. 9-1-1 was called, and R1 was transported to the hospital.

2. SIR dated June 27, 2022: on June 22nd, the hospital requested for a conference call regarding R1's care. During the conference call, the care team was informed that R! has stage 4 cancer. Surgery was not recommended and the plan for R1 was comfort care. On June 27th, R1's case manager was informed about R1's death. R1 passed away at the hospital.

LPA reviewed R!'s file and obtained copies of documents including but not limited to LIC601 Identification and Emergency Information, LIC602 Physician's Reports, facility's documentation on R1's visit with medical providers, Appraisa/Needs and Service Plan, Individual Program Plan

LPA conducted interviews. LPA discussed with licensee the circumstances of the resident's (R1) history and condition.

Exit Interview conducted and copy of this report provided.