Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced case management visit in response to an incident report that was received on 4/21/2025 which described the passing of Client #1 (C1). LPA met with Ella Recla, Direct Support Staff for the facility, and explained the purpose of the visit.

During interviews with staff, they explained that in December of 2024 C1 was hospitalized following a fall, and was diagnosed with cancer. After a biopsy was performed the oncologist determined that they may not live longer than 2 months afterwards. C1 was transferred between Long Term Care facilities and hospitals before they ultimately passed away on 4/20/2025.

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 requested hospital records documenting C1's hospitalization from March of 2025 until their passing.

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.