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 4/1/26. LPA met with Jorgelle Catunao and explained the reason for the visit.

The Department received a Death Report dated 4/1/26 indicating the following:

On 3/12/26 C1 was hospitalized due to severe pain, on 3/31/26 C1’s family decided to put C1 on Hospice Care and C1’s NGT feeding, oxygen and IV fluids were removed, at 9:37am C1 was pronounced deceased, C1’s family was at the hospital when C1 passed.

On 4/8/26 LPA received copies of the following documents via email. C1's Annual Individual Service Plan (IPP) dated 4/9/25, Quarterly IPP dated 3/25/26, Harbor Regional IPP dated 10/3/25, Special Incident Report, Death Report, Medication Administration Records (MAR) for the past 3 months (January-March 2026), Face Sheet and Physicians Report dated 9/5/25.

During todays visit LPA interviewed Assistant Administrator Jorgelle, toured C1's bedroom. (there were no concerns, obstructions, or anything out of the ordinary observed)

LPA has requested facility to obtain and provide Licensing with C1's Death Certificate upon receipt.

No deficiencies were issued during today's visit.

Exit interview held and a copy of the report was provided.