Facility Evaluation Report

On 3/22/23 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced Case Management inspection. LPA met with Sandra Benson , Administrator to discuss the purpose of todays visit which involves gathering additional details surrounding the death of Client #1 which occurred on February 28, 2023.

During the visit LPA reviewed Client #1's file and requested copies of supportive documents (Physician's order, most current Physicians report, most current Nurse's notes). The facility has provided CCLD with the necessary documents requested, and has completed a Death report and SIR within the required time frame.

The Facility currently does not have a copy of the police/fire department report. A copy of the police/fire department report will be forwarded as soon as the Administrator Sandra Benson receives it on 3/27/2023.

LPA interviewed Licensee/Administrator Sandra Benson and S1, client #1 was coming from Dungarvin, Signal Hill Adult Day Program back to the facility. Showing no vitals.

The licensee/Administrator shall submit a copy of the Death Certificate and Police report and LB fire report to LPA Leon upon receipt.