Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced case management visit to follow up on death report faxed to the department on 9/6/23. LPA met with Marlene Urquilla and explained the reason for the visit.

During today's visit LPA Flores reviewed the following documents; death report faxed to the department on 9/6/23. LPA reviewed and obtain copies of physician's report dated: 3/20/23, admission agreement dated: 3/20/23, needs and service plan dated: 3/20/23, medication sheets for August-September 2023, Identification and Emergency Information sheet dated: 3/20/23. LPA interview C1's roommate (C3), and client #2(C2).

Based on documents reviewed C1 was not conserved, ambulatory, and able to take care of self. Per medication sheets C1 took his medication for the past two months. On 9/3/23 Staff #1(S1) checked on C1 at 10:10pm and noticed C1 was sleeping in his bed. At 11:00pm client #2(C2) found C1 in the bathroom floor unconscious and notify S1. S1 contacted 911, police and paramedics arrived. Paramedics attempted to resuscitate C1 and pronounce C1 death at 11:48pm.Police department provided facility with case #PA2023-73531. Police contacted the responsible party notify the death and of need to make arranges for a mortuary to take care of funeral arrangements as the cause of death was due to natural causes. Mortuary services picked up the body. Administrator provided C1's belongings to family on 9/5/23.

No deficiencies were observed during this visit and LPA requested Administrator to forward death certificate to the department upon receiving it.

Exit interview was conducted with Marlene Urquilla and a copy of this report was provided.