Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted and unannounced case management visit regarding death report received on 6/5/23. LPA met with Staff Andrew De Vera and the purpose of the visit was discussed.

Licensing received death report on 6/5/23 for Client #1 (C1). On todays visit, LPA interviewed Staff #1-#2 (S1-S2). LPA was informed that C1 went out the hospital on 5/11/23 due to pain and discomfort. C1 was then admitted to a skilled nursing facility on 5/19/23 instead of returning to the facility. The skilled nursing facility then transferred C1 back to a hospital on 5/27/23 where C1 passed away that day. C1 had a diagnosis of breast cancer that dates back to 2021 and refused to receive treatment. C1 did not pass away in the facility and was present in the facility since 5/11/23. LPA confirmed during review of C1's file.

During the visit LPA obtained staff, resident roster, C1s Identification and Emergency Information, physician’s report, needs and services plan, 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.

Facility 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.