Facility Evaluation Report

On 07/17/2025 at 12:00pm Licensing Program Analysts (LPAs) L. Alexander and K. Nguyen arrived unannounced to conduct a case management visit to follow-up on a death report received by Community Care Licensing that was faxed on 07/14/2025. LPAs met with Executive Director, Jon McCraw and explained the purpose of the visit.

Resident (R), R1, passed away on 07/14//2025 with an unknown cause of death. LPAs interviewed Staff (S), S1, that stated S1 saw R1 earlier in the morning approximately 7:45 am on 07/14/2025 to deliver R1 breakfast. S1 stated that R1 was up and when asked R1 stated R1 felt ok. S1 stated S1 returned back to R1's room just to check in and observed R1 sitting at R1 dining room table and slouched over R1 walker. S1 called the Med Tech to R1's room and Medtech started cardiopulmonary resuscitation (CPR) on R1. LPA's reviewed LIC 624, and Death Report indicated that the cause of death was unknown declared by the paramedics when they arrived.

During today's visit LPAs obtained additional information pertaining to R1's death:

S2 will obtain death certificate and will send to LPA

Exit interview conducted and a copy of this report was provided.