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 3/11/25. LPA met with Melanie De Ocampo and explained the reason for the visit.

The Department received a Death Report dated 3/11/2025 indicating the following: On 1/22/25 C1 was hospitalized and discharged back to facility on 3/7/25, while hospitalized C1 was in and out of the ICU. On at 3/11/25 7:30am staff noted no pulse, S1 performed CPR right away, while S2 called 911, paramedics arrived and were able to get a pulse but lost it again, paramedics continued to revive C1 until 8:29am when C1 was pronounced deceased.

During today's visit LPA interviewed Co-Administrator Jorgelle Catunao via phone.

LPA has requested for the facility to provide the following documents via email before end of day 4/4/2025: C1's FACE Sheet, Appraisal Needs & Services Plan/IPP, Physician's Report, Medication Administration Record (MAR) for January-March 2025, and Home Health Documents.LPA has also requested facility to obtain and provide Licensing with C1's Death Certificate upon receipt.

LPA toured C1's bedroom. No concerns, obstructions, or anything out of the ordinary was witnessed

No deficiencies observed during today's visit.

Exit interview held and a copy of the report was provided. LPA will also email a copy of this report to Administrators Jorgelle and Mark.