Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced case management visit to follow up on an incident report that explained the passing of Client #1. LPA met with Jocelyn Ruiz, house manager for the facility, and explained the purpose of the visit. Administrator Crysel Santos arrived shortly thereafter.

During interviews with staff they explained that C1 was hospitalized for weakness, loss of appetite, and weight loss. On 1/10/2025, a staff member noticed that C1 was coughing and also noticed that blood was coming from C1's right eye. Staff accompanied C1 to the hospital and C1 was admited the same day. C1 was later transferred to Orchard Post Acute Care on 1/15/2025. On 1/17/2025, C1 went into cardiac arrest and passed away on 1/17/2025. At this time a cause of death is unknown.

During the visit LPA obtained the resident's FACE Sheet, most recent Physician's Report, most recent Individual Program Plan (IPP), and the Medication Administration Records (MARs) for the past three (3) months for C1. LPA also obtained the hospital discharge paperwork along with documentation from the Skilled Nursing Facility C1 was staying at between 1/15/2025 - 1/17/2025. LPA requested that the administrator submit the death certificate of C1 to LPA as soon as it becomes available.

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