Facility Evaluation Report

Licensing Program Analyst (LPA) Kruz Long conducted a Case Management visit to follow-up on the death of Client #1. LPA met with Mari Harris who assisted with the visit. LPA explained the purpose of today's visit.

Per Special Incident Report, Client #1 started to have a seizure on 01/21/22 around 5:55 pm and Staff #1 called 911. Ambulance arrived at the facility at 6:02 pm and Client #1 was taken to the hospital. At approximately 7:02 pm, the hospital called the facility and notified the facility of Client's death.

Copies of the following documents were obtained during today's Case Management visit:

Facility was unable to provide a copy of the death certificate. Administrator was informed to provide the death certificate to LPA once it becomes available.

Exit interview conducted and a copy of this report provided to Mary Harris.