Facility Evaluation Report

On 7/28/2022 at 10:30AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit in regards to death report received on 7/22/2022. LPA met with Administrator, Marilyn Daguio.

Death report dated 7/22/2022 stated that C1 was sent to the hospital due to breathing heavy and fast, bluish tongue and fingernail beds on 7/12/2022. C1 was placed on antibiotic for sepsis and was placed on comfort care on 7/21/2022 at the hospital. C1 passed away at the hospital on 7/22/2022.

During visit, LPA interviewed S1 and was informed that C1 was sent to the hospital on 7/11/2022. LPA verified on facility notes that C1 was sent to the hospital on 7/11/2022. LPA advised Administrator to update death report and resubmit it to CCLD. LPA reviewed C1's file and observed C1 has a primary diagnosis of chronic respiratory failure. Facility notes indicated that S2 observed C1 breathing heavy and S2 called 911. Paramedics arrived shortly after and took C1 to the hospital. C1 passed away at the hospital.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.