Facility Evaluation Report

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced case management visit to follow up on a death report faxed to the department on 08/16/24. LPA met with Ruvy Pelesasa (House Manager ) and explained the reason for the visit.

During today's visit LPA Mora reviewed and obtained copies the following documents: Client 1 (C1) death report, physician's report, Individualized Program Plan, medication sheets for June 2024 - August 2024, Identification and Emergency Information sheet. LPA interview the House Manager, Staff 1 (S1), Client 2 (C2), and Client 3 (C3). Based on documents reviewed C1 was 56 years old, ambulatory, not able to care for all personal needs, needed assistance with activities of daily living (ADLs), and was conserved by a family member. Per medication sheets, C1 took all medication for the past 3 months as prescribed. C1 started having a cold and fever on 08/03/2024. The next day 08/04/2024 C1 appeared to be good, but just sleepy. On 08/05/2024, C1 got sick again and on 08/06/2024 morning C1 was a lot worse and did not appear to be getting better so the facility did a virtual urgent care, but they were instructed to take C1 to the emergency room. Facility call 911 and paramedics took C1 to the hospital on 08/06/2024. C1 was at the hospital from 08/06/2024 to 08/15/2024. She was diagnose with pneumonia and low oxygen levels. She was intubated. On 08/10/24, the tube was removed and C1 appeared to be well. On 08/12/24, the doctor determined that C1 needed to be re-intubated because C1 lungs kept getting a blockage. On 08/15/24, C1 appeared to be stable and they removed the tube, but C1's oxygen levels were low and had trouble breathing. It was decided to not re-intubate C1 anymore and C1 passed away on 08/15/2024 10:58pm.

No deficiencies were observed during this visit and LPA requested a copy of the death certificate to be forwarded to the department upon receiving it.

Exit interview was conducted and a copy of this report was provided.