Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the Administrator. LPA Spaeth stated the purpose of the visit was regarding an incident report and death report received by Community Care Licensing.

Community Care Licensing received an incident report dated 4/09/2024 stating a resident passed way on 4/09/2024 at 6:20 am.

LPA Spaeth reviewed resident's file (R2) from 1:50 pm until 2:15 pm. LPA received copies of the documents. LPA interviewed a resident and one staff member at 2:10 pm until 2:30 pm.

LPA Spaeth will be conducting additional staff interviews and will return to the facility at a later time.

Exit interview conducted and a copy of the signed report was given.