Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent case management visit in response to an initial case management dated 1/28/2025 following the death of Client #1 (C1), who passed away at a Skilled Nursing Facility (SNF) on 1/17/2025. During the initial visit, LPA obtained C1'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. Since the initial visit, facility staff submitted the death certificate of C1 to LPA. Today, LPA will be delivering the findings of the investigation.

On 1/10/2025 C1 was hospitalized for weakness and loss of appetite on 1/10/2025, and was lated transferred to a SNF on 1/15/2025. C1 passed away on 1/17/2025 after they went into cardiac arrest. The death certificate of C1 explains that the immediate cause of death was cardiopulmonary arrest, with underlying causes including acute hypoxemia and pneumonia. The death was determined to be not suspicious.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED .

Exit interview held, and a copy of this report was provided.