Facility Evaluation Report

On 07/15/2026 at 3:00 PM, Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding an incident reported to Community Care Licensing Division (CCLD) on 03/27/2026. LPA met with Campus Administrator, Michele Sheldon, and explained the purpose of the visit.

The Unusual Incident Report (LIC 624) indicated that at approximately 9:15 AM on 03/27/2026, Staff (S1) went to Client (C1)'s room to prompt C1 for the scheduled medication pass. According to the report, S1 had previously attempted to wake C1 earlier that morning; however, C1 did not get out of bed. Upon returning to the room, S1 observed C1 lying face down in bed and unresponsive. S1 attempted to wake C1 by shaking them and observed vomit near C1 while C1 appeared to be gasping for air.

S1 immediately called 911 while S2 and S3 initiated cardiopulmonary resuscitation (CPR) and applied the automated external defibrillator (AED). Emergency medical personnel arrived on scene and assumed resuscitative efforts. According to the incident report, after approximately 30 minutes of lifesaving measures, the Fire Captain pronounced C1 deceased at 9:55 AM. The Coroner's Office arrived at approximately 11:00 AM and took custody of C1's remains.