Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced case management visit. LPA met with Supervisor Julia Elias and explained the purpose of the visit.

Licensing received an incident report on 11/18/22 of Client #1 (C1) being found unresponsive in their room on the morning of 11/18/21. Staff conducted a room check as C1 did not come down for their morning medications. Incident report stated that 911 was called and paramedics arrived. Paramedics told staff that C1 passed away.

During the visit LPA obtained staff, resident roster, C1s Identification and Emergency Information, physician’s report, and medication log. During todays visit LPA conducted a health and safety check and toured the physical plant. LPA observed the food supply. LPA observed sharps, medications, and chemicals under lock. There were no health and safety concerns at the time of the visit.

LPA interviewed the Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3). Interviews stated that on 11/18/22, staff conducted a room check to look for C1 as C1 had not come down for their medication. C1 was found unresponsive in their bed in a position that looked as if they were clutching their chest. 911 was immediately called and Paramedics stated that C1 had passed away. C1's responsible party was also immediately notified.

Administrator to obtain a copy of death certificate and provide to Licensing when available.

Exit interview was conducted and a hard copy of this report was provided.