Facility Evaluation Report

Licensing Program Analysts (LPAs) Tena Herrera and Gabriela Castro conducted an unannounced Case Management Visit to follow up on a Death Report emailed to the Department on 9/3/25. LPA met with Josue Pompa - DSP and explained the reason for the visit, LPA also spoke with Administrator Eboni Campbell to gather additional information.

The Department received a Death Report dated 9/3/25 indicating the following: C1 had been experiencing flu like symptoms and congestion since 8/30/25, physicians after hours office was called and it was advised not to take client to urgent care as it sounded like a common cold and were instructed to follow up with primary physician on Monday 9/1/25, on Monday 9/1/25 staff contacted primary physician in the morning and was told that the doctor would contact facility for a virtual visit but no call from physician came, during 4am rounds staff noticed there was no response from C1, no pulse was found and 911 called, paramedics arrived and the determined time of death was provided as 4:40, with no reason for death.

LPAs obtained copies of the following documents within C1's file: Physician’s Report, Face Sheet, Medication Administration Records (MAR) for the past 3 months (June-September 2025), most recent doctors visits.

LPAs have requested for the facility to provide the following documents via email before end of day 9/4/2025: most current Appraisal/Needs and Services Plan (or IPP) and Death Report, staff charting notes from 8/1/25 until death.

LPAs has also requested facility to obtain and provide Licensing with C1's Death Certificate upon receipt.

LPAs toured C1's bedroom. No concerns, obstructions, or anything out of the ordinary was witnessed.

No deficiencies observed during today's visit.

Exit interview held and a copy of the report was emailed to Administrator Eboni Campbell.