Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced Case Management Visit to follow up on a Death Report faxed to the Department on 5/28/24. LPA met with Administrator Heinrich Gonzales and explained the reason for the visit.

The Department received a Special Incident Report dated 5/28/2024 indicating the following: On 5/27/24 at approximately 11:10am C1 was having lunch and suddenly started to spit out their food, they were observed having grimacing expressions and he lost consciousness, 911 was called immediately while other staff began to administer CPR, paramedics arrived and took over at approximately 11:20, however, C1 was pronounced deceased at 11:25 by the paramedics.

During today's visit LPA interviewed the Administrators Heinrich Gonzales and Merci Gonzales and (1) Caregiver, obtained copies of C1's FACE Sheet, Death Report, Appraisal Needs & Services Plan, Physician's Report, and Medication Administration Record (MAR) for March 2024-May 2024.

LPA also toured C1's bedroom. No concerns, obstructions, or anything out of the ordinary was witnessed LPA has requested facility to obtain and provide Licensing with C1's Death Certificate upon receipt.

No deficiencies observed during today's visit.

Exit interview held and a copy of the report was provided to Administrator Merci Gonzales.