Facility Evaluation Report

Licensing Program Analyst (LPA) Stephanie Cifuentes initiated a case management visit regarding an incident reported to CCL on 2/7/2022. LPA arrived and called Administrator Stephanie Brown to complete facility risk assessment. LPA informed staff that the reason for the visit was due to the incident which occurred on 2/8/2022 and was allowed entry.

During todays’ visit LPA interviewed administrator, staff and toured physical plant. On 2/8/2022 client 2 (C2) heard client 1 (C1) fall out of bed, when C2 could not awaken C1, C2 called staff who called 911. Paramedics arrived and after performing CPR declared C2 dead. Cause of death was not given.

LPA requested the following documents: Staff roster, staff schedule, needs and services plan, MAR, and Physicians Assessment for C1.

A request was made to provide a copy of the death certificate when it becomes available.

No deficiencies will be cited at this time, additional investigation is required which includes analysis of the records obtained and follow up interviews.

Exit interview held and a copy of report provided to administrator Stephanie Brown