Facility Evaluation Report

On 5/26/2026, Licensing Program Analyst (LPA) Jewel Baptiste conducted a case management visit for the death of Client 1 (C1) which occurred on 5/18/26. LPA met with Facility Staff Adelia Gomez, who contacted the Administrator. The Administrators Mirafy and Archimedes Lopez arrived at 1:59 and LPA explained the reason for the visit. Around 2:25 pm Administrator Mary Gonzales arrived and assisted with the visit.

According to the death report received on 5/19/2026. C1 has been treated at the Hospital since 5/9/2026. They believed C1 was getting better on 5/11/2026, but comfort measures were initiated on 5/18/2026 after starting to decline on 5/16/2026. The death report stated possible contributing factors, but the death certificate is pending. Facility will send it as soon as they receive it from the family.

During today’s visit, the administrator stated that C1 was sent to the hospital on 5/9/2026 due to increased confusion, low oxygen and low heart rate. The administrator further stated the Staff roster and Client roster, C1 IPP, Client #1 (C1) face sheet, C1's last medical visit, C1's Admission agreement, and C1's MAR medication record was faxed to CCLD. LPA toured C1’s bedroom and did not observe anything suspicious.

Based on the available information reviewed, LPA did not note any deficiencies in reference to C1's death. Exit interview conducted and copy of report was provided to the Administrators.