Facility Evaluation Report

Licensing Program Analyst (LPA) Jeyde Cardenas conducted a Case Management visit in relation to the death of client #1. Death report received on 11/29/21. LPA met with Administrator, Sharron Babb and discussed the purpose of the visit. LPA conducted risk assessment to ensure facility is clear of covid-19 infection, facility was deemed clear of Covid-19.

During today's visit, LPA interviewed Administrator and staff present at the time of visit, LPA attempted to interview client#2 and client#3, and toured the physical plant. LPA was informed that on 11/25/21 client #1 was found in bed unresponsive and emergency response was contacted. Staff #1 administered CPR until the Paramedics arrived. Emergency response attempted to revive Client #1, however client was pronounced deceased at the facility.

On 12/2/21 LPA Cardenas was provided with copies of the following documents via email.

· Most recent medical Appointment records

· Annual behavior assessment dated: 01/22/21

LPA requested the Administrator, provide a copy of the death certificate when it becomes available.

Exit interview held and a copy of report provided to Sharron Babb .