Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced case management visit regarding client #1 (C1)'s death which was occurred on 05/01/26. LPA met with Administrator Joey. District manager Nicole Snyder joined the visit shortly after. LPA explained the reason of the visit to them.

Administrator Joey notified Licensing regarding C1’s death over the phone on 05/01/26 and submitted a death report on 05/03/26. According to the death report dated 05/03/26, C1 deceased on 05/01/26 in the hospital after client fell on the floor in the facility on 04/28/26. The suspected cause of death was unknown at the time of the visit.

During today's visit, administrator was interviewed, C1's file was reviewed, a physical plant tour was conducted at client#1’s bedroom/bathroom and obtained the following:

· C1’s Medical Administration record (Feb and Mar 2026)