Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent unannounced case management visit to follow up an incident report that was received on 12/17/2024, which described the passing of Client #1 (C1). LPA met with Blessing Obuna and explained the purpose of the visit. Administrator Ifunanya Ifeacho was notified of the visit by phone call.

The investigation consisted of the following: During the initial visit conducted on 12/31/2024, LPA obtained the resident's FACE Sheet, Physician's Report, most recent Individual Program Plan (IPP), and the Medication Administration Records (MARs) for the past three (3) months for C1. Since the initial visit, LPA obtained the death certificate of C1.

The investigation revealed the following: During interviews with staff, they explained that C1 was rushed taken to the hospital on 12/17/2024 after C1 told staff that they were feeling unwell. When they arrived at the hospital, C1 had slumped over after walking for about 10 meters and collapsed on the fllor, which prompted them to call hospital staff for assistance. Hospital staff proceeded to perform CPR on the client, however C1 was pronounced deceased shortly thereafter. The death certificate of C1 reveals that they passed away due to Cardiopulmonary Arrest, with secondary and third causes respectively being Cardia Arrhythmia and Cardiomyopathy.

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.