Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced initial case management visit regarding the death of client #1 (C1) which occurred on 1/8/2022. LPA met with staff, Alfreda Garner and spoke with Administrator, Kristen Wooten Newman over the phone and explained the reason of the visit.

According to the incident report dated 1/10/22, C1 passed away on 1/8/22 in the hospital. The suspected cause of death is Cardio-Pulmonary Arrest. C1 had Covid positive and finished with quarantine.

During today's visit, administrator was interviewed, C1's file was reviewed and obtained the following:

· Unusual incident reports, dated 1/10/22

· C1's record of Medical visit dated 4/12/21

· C1's medication record (MAR) dated Dec 2021 and Jan 2022

· C1's annual report / IPP - year of 2021. Due 1/26/22

Administrator stated she may get the death certificate and coroner report from C1's family when available. Exit interview was conducted and a copy of LIC 809 Report was provided to staff