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 10/17/24. LPA met with Crestine Dapedran (Caregiver) and explained the reason for the visit.

Per Conversation with Melanie (caregiver), on 10/17/24 Client #1 (C1) was discovered as unresponsive as they were being prompted for wake up and shower, there was an attempt to retrieve vitals and staff were not able to get any readings, C1 was on hospice and hospice was called right away. The day prior C1 appeared to be their normal self, strong and ate well before bed, there was nothing unusual. Hospice confirmed time of death as 7:15am on 10/17/24.

On 10/17/24 (via email) LPA received the following copies from C1’s file : FACE Sheet, Death Report, Appraisal Needs & Services Plan, Physician's Report, and Medication Administration Record (MAR) for August - October 2024.

During today’s visit, LPA toured C1's bedroom which had already been cleared out by hospice and family. No concerns, obstructions, or anything out of the ordinary was witnessed during the visit. LPA has also requested facility to 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 Crestine Dapedran (Caregiver).