Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted a case management visit to follow-up on the death of Client 1 (C1). LPA met with Gloria Zagala, Supervisor and explained the reason for the visit. Shortly after, Stanley Kaniel, Administrator arrived and assisted LPA with the visit.

During today's visit LPA interviewed the Administrator, Staff #1 (S1) - Staff #2 (S2) and C1's roommate, Cclient# (C3) and Client #4 (C4). LPA obtained copies of client's roster, C1's FACE Sheet, Physician's Report, Functional Capability Assessment Appraisal Needs and Services Plan and Medication Administration Record (MAR) for May-July 2023.

According to the death report dated 07/21/2023, C1 passed away at the facility on 07/21/2023 at 6:24am. C1 passed away in his sleep and cause of death is unclear at the moment. Incident report (SIR) was submitted by the Administrator on 7/25/2023 and stated that C1 refused to see the doctor who visited the facility on 7/17/2023. At approximately 5:45am, C2 (C1's roommate) along with C3 went to tell the staff on duty that C1 was unresponsive on his bed and to come check on him. C4 called 911 and was instructed to perform CPR to C1 while on the phone with 911. Paramedics then arrived a few minutes later and took over in performing CPR. C1 was pronounced dead at 6:24am. Sheriff's Dept. deputy was also present and stayed to watch the remains until Medical Examiner arrived and took C1's body away. Administrator came to the facility also and spoke to C1's family members to inform them of his death.

LPA also toured C1's room. No concerns, obstructions, or anything out of the ordinary was witnessed during the visit. Administrator was also asked to provide a copy of the death certificate when it becomes available.

No deficiencies observed during today's visit. Exit interview held with Stanley Kaniel, Administrator and a copy of the report was provided to the facility.