Facility Evaluation Report

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima for a case management visit to follow up with the incident report provided to the Licensing office on 06/26/26, informing that resident #1 (R1) became unresponsive during bathroom assistance. 911 was called and R1 was sent to the hospital.

During conversation, LPA was informed that R1 was admitted to the facility with a G-tube, R1 was unable to self-assist with a G-tube and was not a hospice resident. LPA made a follow-up contact and spoke with the staff and Administrator.

Information received revealed that R1 was admitted, retained and readmitted to the facility with prohibited health conditions that required higher level of care.

Therefore, LPA conducted follow up visit to get additional information regarding resident health conditions and other surrounding circumstances of the incident.

During the visit, at 3:00p.m., LPA toured the facility and at about 3:20p.m., LPA spoke with staff and R1. In addition, at approximately 3:45p.m., LPA reviewed R1’s file.

A review resident R#1 (R1) records conducted at revealed the information regarding R1’s home health care services and medical conditions.

LPA observed that R1 has a gastrostomy (G) tube. R1 stated that Staff #1 (S1) oversee their daily G-tube care, while the home health nurse visits once weekly. Record reviewed and staff interview indicated the resident is unable to independently perform all aspects of G-tube feeding and care.

During this visit LPA Alvizar-Ettima also discussed Title 22 regulations pertaining to restricted and prohibited