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 8/26/25. LPA met with Caregiver Maria Teresa Alpay and explained the reason for the visit, shortly after Administrator Jorgelle arrived to assist with visit.

The Department received a Death Report dated 8/26/2025 indicating the following: On 8/12/25 C1 was hospitalized, during hospitalization C1 was placed on Hospice Care and was discharged back to facility on 8/21/25. On 8/26/25 at 7:30pm C1 was pronounced deceased and their hospice nurse was with C1 in last moments until C1 passed.

During today's visit LPA interviewed Caregivers S1 and S2, and obtained copies of the following documents. C1's most current Physician’s Report, Face Sheet, Incident Report, Hospice Documentation, and Medication Administration Records (MAR) for the past 3 months (June-August 2025).

LPA has requested for the facility to provide the following documents via email before end of day 8/29/2025: C1's most current Appraisal/Needs and Services Plan, and Hospice Notification.

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 emailed to Administrators Jorgelle and Mark.