Facility Evaluation Report

On 1/10/2024 at 11:20 AM (LPA) A. Gomez arrived unannounced to conduct a Case Management in regards to an incident report submitted to CCLD on 1/5/2024. LPA met with administrator Josefina Gardner and explained the purpose of the visit.

On 1/5/2024 CCLD received an incident report stating that R1 had passed away on 1/1/2024 in their sleep after being checked on by a caregiver arround 2:30AM. When caregiver retuned at 5:00AM resident was unresponsive. LPA obtained a copy of R1's death certificate that states that resident passed due to Emphysema. R1 also had other conditions such as hypertension and lung disease. LPA also obtained a copy of R1's physicians report.

Exit interview conducted with Administrator and a copy of this report provided