Facility Evaluation Report

Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced case management visit regrading a death of a client who resided at the above facility. LPA discussed the purpose of todays visit with Assistant Administrator Estefany Lopez. On 6/23/23, LPA Calderon received Death Report from the above facility. Regarding client #1 (C1's) death.

On 6/22/23 based on Special Incident Report C1's roommate witnessed C1 stumble and clutching chest and fell to the ground. Roommate informed staff. Staff called 911, when 911 arrived C1 was transported via ambulance to Huntington Hospital Emergency Room for further assistance. Client passed away when admitting to the hospital. Per Huntington Hospital cause of death was said to be: Cardiac Arrest. Client passed away on 6/22/23 at the Hospital at 9:30pm. Client was self responsible. Assisted Living Wavier Program notified as well as client’s mother and sister were informed about incident leading to death. No recent hospitalization's stated on Death Report provided to Licensing. Death Report submitted to licensing.

On 6/23/23 LPA Calderon reviewed and received : Client’s Physician Report dated 3/10/23, Face Sheet, Pre Placement Appraisal , Functional Capability Assessment and Latest Medication Records (MARS) for June/July.

On todays visit 7/6/23 LPA Calderon requested: staff and resident roster, C1 Shift Report, Current Appraisal / Needs and Service Form, medication log for April / May 2023, and Medical Records . LPA alongside with Lopez toured facility. Facility has 1 main building and 4 cottages, common areas: outside patio spaces, dining/ activity room, tv room, north wing activity room, main activity room and kitchen. Sufficient perishable and non-perishable food items were observed for clients in care. LPA toured C1's room, rooms # 2,3,27,35,38,41 and 45. Continuation 809-C...