Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent 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 Surenz Vincent Apao, caregiver for the facility, and explained the purpose of the visit. Administrator Joann Mocling was notified of the visit by phone call.

The investigation consisted of the following: During the initial visit conducted on 4/29/2025, 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. Since the initial visit, LPA obtained hospital records and the death certificate of C1.

The investigation revealed the following: 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. C1's death certificate indicates they passed away at the hospital due to Acute Hypoxic Respiratory Failure.

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 that the death of C1 was suspicious, and therefore the concern is UNSUBSTANTIATED .

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