Facility Evaluation Report

On 11/5/2021, Licensing Program Analyst (LPA) Nina Galarza conducted a case management visit to follow up on death reported for Client #1 (C1). LPA met with Dana Ordonez, Assistant Administrator and explained the reason for the visit.

LPA received death report for client #1(C1) on 10/30/21 via email. During today's visit, LPA interviewed Assistant Administrator and C#1's room mate, Client #2 (C2). On 11/1/2021, LPA interviewed Administrator Crysel Santos telephonically. On 11/5/2021 Assistant Administrator stated on 10/29/2021 at 4:45 p.m. C1 had a change in condition, C1 developed a tremor and reported hearing voices. Facility called 911 and paramedics arrived at 4:50 p.m.; paramedics took vital signs and reported all vital signs were normal. C1 refused to go to hospital. On 10/30/2021 at 6:30 a.m. Staff 1 (S1) observed C1 unresponsive. S1 performed CPR, and facility called 911. Paramedics arrived at 6:45 a.m and also performed CPR, but resident was unresponsive. C1 was last seen by medical physician and provided an evaluation on 9/16/21, no concerns were address or noted.

The following documents were obtained on today's visit:

Medication Administration Record (MAR) for C1, dated September 2021 - October 2021

recent doctor visit report, dated September 2021

recent psychiatry visit report, dated September 2021

refusal of treatment report, dated 10/29/2021