Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced case management visit at the facility to follow up on death report submitted to the department on 12/28/24. LPA Flores met with Soledad Bernal and explained the reason for the visit.

On 12/28/24 facility staff submitted a death report for client #1(C1). During this visit, LPA conducted interviews with administrator and staff #1(S1), and collected the following documents, incident report dated 11/30/24, and 12/28/24, physician's report dated:3/21/24, individual person-center plan(IPP) dated 8/28/24, admission agreement, hospital discharge dated:12/10/24-12/24/24 medication sheets for November and December 2024, nursing assessment date: 10/30/24, face sheet, physician's progress note dated: 3/26/24, order appointing probate conservator dated 10/14/24.

Per staff on 12/28/24 C1 was being assisted by S1 during dinner to eat a soft diet. S1 noticed C1 stop eating, moving, and breathing. S1 asked administrator to come into the dining room and check on C1. Administrator checked C1's mouth to ensure C1 did not have something obstructing airways and called 911. Paramedics arrived within 4 minutes and connected C1 to monitor a pulse. Per administrator C1's conservator was called and indicated over the phone to not resuscitate (DNR) C1. Paramedics disconnected their equipment and declared time of death. C1's conservator indicated mortuary will be picking up C1. Sheriff's department arrived and provided incident #24363-0094.

Additional information is required for this case management. Administrator will obtain a copy of C1's death certificate, hospital intake for 11/30/24, and DNR documents and submitted to the department by 1/28/25.

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