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 3/19/25. LPA met with Mercedes Bedolla and explained the reason for the visit.

The Department received a Death Report dated 3/19/2025 indicating the following: On 3/19/25 Staff #1 called paramedics for Client #1 (C1) due to weakness and difficulty breathing, 3/17/25 C1 was admitted due to decline in condition and around 6:30pm facility was contacted by C1’s family about their passing. There were no previous serious health issues/concerns.

During today's visit LPA interviewed Administrator/Licensee via phone call and interviewed S3 in person at the facility.

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, and Medication Administration Record (MAR) for January-March 2025.

LPA has 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 Licensee/Administrator Jose De La Cruz