Facility Evaluation Report

On 12/07/22 at 1:45PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced case management visit regarding an incident report faxed to CCL on 12/06/22. LPA explained the purpose of the visit with the Care Coordinator (CC).

CC stated resident (R1) was first admitted at the facility on 12/10/2012. CC stated R1 was verbal, ambulatory, independent and did not display any signs of pain or discomfort. Staff stated R1 passed away on 12/06/22 at approximately 7:20AM in her sleep. Staff called 911 to report the death. Police arrived 12/06/22 and conducted a welfare check. R1's body was released by the coroner's office the same day. Administrator requested for a copy of R1's death certificate and will submit it to CCLD once available.

Exit interview conducted and a copy of this report provided.