Facility Evaluation Report

Licensing Program Analysts (LPAs) Bennette Pena and Gabriela Castro conducted an unannounced case management visit in response to a reported death incident of Client #1 (C1), who passed away at the hospital on 05/09/2025. LPAs met with Arturo Calderon, Direct Support Professional I (DSP I) and explained the purpose of the visit. Shortly after, Ann Hamilton, Licensee/Administrator arrived and assisted LPAs.

The incident report stated that on 05/09/2025, Staff #1 (S1) found C1 on the floor throwing up. S1 quickly turned C1 on his side and called 911. Paramedics took C1 to the hospital, where S1 noted that C1 was still conscious. However, C1 later died in the hospital on the same day due to choking, as noted in the death report sent by the Administrator to CCL.

Prior to the visit, LPA Pena obtained a copy of the staff and client rosters and documents for C1 such as Identification and Emergency Information (Face Sheet), Functional Capability Assessment, Appraisal/Needs and Services Plan, Medical Progress Notes (04/02/2025), Physician’s Report (04/20/2025), Medication Administration Records (MARs) (Feb-May 2025) and Death report.

During today’s visit, LPAs obtained a copy of C1's IPP (dated 01/06/2020) and toured the physical plant including C1’s bedroom and found no issues. LPAs requested C1's latest Individual Program Plan (IPP) and hospital discharge paperwork to be emailed to CCL. Licensee/Administrator was also asked to provide C1's death certificate to CCL when it becomes available.

No citations issued. An exit interview was held and a copy of this report was provided to Ann Hamilton, Licensee/Administrator.