Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted a case management visit in response to a death report that was submitted to CCLD on 11/25/22. LPA met with the House Lead, Ariel De La Cruz, and explained the purpose of the visit.

The death report indicated that Client #1 (C1) passed away at the hospital on 11/25/22 at 12:43 a.m. LPA conducted interviews with the Administrator and 3 Staff. Per interviews, on 11/23/22, the facility obtained results for C1 who tested positive for COVID-19, along with another client in the home. Staff kept close monitoring of C1 and checked vitals throughout the day and night. There were no signs of distress nor COVID-19 symptoms coming from C1. Due C1's uncontrollable movements and could not obtain accurate oxygen level readings which fell below 90%, the Administrator instructed the NOC shift staff to contact 911 on 11/24/22 at approximately 5 a.m. The paramedics came and took C1 to the hospital. Per the Administrator, the vitals taken at the hospital were within normal range and C1 had an oxygen level of 96%. However, C1 went into cardiopulmonary arrest at the hospital and resuscitation was attempted on 11/25/22.

LPA requested for the following documents:

* Face Sheet, MAR log for September through November 2022, IPP, Physician's Report, and death certificate.

LPA did not note any deficiencies during the visit today. An exit interview was conducted and a copy of this report was provided to the house lead.