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 10/31/24. LPA met with Lydia Caranto and Ayub Walayat and explained the reason for the visit.

Per Conversation with Administrator Ayub Walayat, whenever C1 had UTI or Pneumonia their heart rate increased, C1 had gone to the doctor in the morning of 10/28/24 to get clearance for a surgery, the doctor prescribed medication for pneumonia and later that afternoon, back at facility, C1 looked very lethargic and weak, staff called the doctor and were instructed to take C1 to the ER. C1 passed the following morning 10/29/24 in the hospital. C1 has had a history of UTI and Pneumonia and I have submitted SIR's for his multiple doctor visits and hospitalization's due to health conditions.

During today's visit, LPA received the following copies from C1’s file : FACE Sheet, Death Report, Appraisal Needs & Services Plan, Physician's Report, and Medication Administration Record (MAR) for August - October 2024.

LPA toured C1's bedroom. No concerns, obstructions, or anything out of the ordinary was witnessed during the visit. LPA has also requested facility to provide Licensing with C1's Death Certificate upon receipt.

No deficiencies observed during today's visit. Exit interview held and a copy of the report was provided.