Facility Evaluation Report

On 07/05/23, Licensing Program Analyst, LPA Alfonso Iniguez conducted a Case Management visit to follow up on the death report that department received on 7/3/23. LPA was greeted by Joyce Garcia/Assistant Administrator (S1) an explained the purpose of the visit is to gather information surrounding the death of (C1).

The regional office received a copy of the death report from the facility and reported the death of (C1) on 07/03/23. The death report stated that (C1) passed away on 07/03/23 at 12:10 AM in room 11 at the facility.

The following documents and interviews were retrieved and conducted:

· Client Tracking Notes and documentation of staff rounds for the months of: May, June, and July of 2023.

· LPA conducted Interviews with the following: S1-S3 and C2-C11.

· LPA reviewed 7/2/2023 and 7/3/2023 PM video recording.

LPA requested a copy of the coroner’s report, police report, death certificate and a copy of the CCTV video footage form 7/2/23 at 5:00PM-7/3/23 at 2:00AM. Once obtained, facility will provide a copy to the regional office.

An exit interview was conducted with Joyce Garcia/Assistant Administrator and a hard copy was provided.