Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced Case Management Visit to follow up on a Death Report received on 08/18/2025. LPA was met by Care giver Sunday Lanting and explained the purpose of the visit. Administrator Ruby Pelesasa was notified by telephone.

Licensing received an email to report death of Resident #1 (R1) on 08/18/2025. Death occurred in the hospital on 08/16/2025 with family by his/her side.

On 08/15/2025 around 7:30 AM staff # 1 (S1) went into R1’s room to change him/her and noticed R1 was experiencing shortness of breath and weak. R1’s hands and feet were cold. Paramedics were called and R1 was taken to hospital via ambulance. R1 passed away the next day in hospital.

During today's visit LPA spoke to Administrator and staff S1 over the telephone. LPA also toured R1's bedroom. No concerns, obstructions, or anything out of the ordinary was witnessed during the visit. Administrator had provided via email R1’s Physician’s Report, Medication Administration Record (MAR), face sheet, functional capability assessment, nurse visits, and current appraisal. LPA will also request facility to obtain and provide Licensing with R1's Death Certificate upon receipt if available.

No deficiencies observed during today's visit. Exit interview held and a copy of the report was provided to the facility.