Facility Evaluation Report

On 5/4/2023, Licensing Program Analyst, LPA Martessa Brown conducted a Case Management visit to follow up on the death reported for Client #1 (C1). LPA was met by Itzia Maciel Assistant Administrator and explained the purpose of the visit was to gather information surrounding the death of (C1).

The regional office received a fax copy of the incident and death report involving the death (C1) on 4/14/2023. The Incident report stated that on 4/12/2023 (C1) was found by staff #1 (S1) at 10:00 PM, in the bed and was unresponsive. Staff #1 called 911 and the police and paramedics came out to the facility. C1 was pronounced dead. On 5/2/2023, LPA Spoke to administrator and obtained and rec’d a copy of C1's Death Certificate.

On 5/4/2023, LPA conducted an interview with Assistant Administrator. LPA attempted to interview the C1's roommate but was not available. LPA toured the physical plant. Resident bedroom was inspected and all of C1 belongings have been removed.

A copy of the following documents was provided to LPA: C1 physician report, emergency contact, mar’s list, admission agreement and staff/resident roster.

LPA did not observe deficiencies therefore no citations were issued during this time.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to the Itzia Maciel. Assistant Administrator.