Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced case management visit in response to a death report received on 8/15/2024 for Client #1 (C1). LPA met with Evelyn Guerrero, Direct Support Staff (DSP) for the facility, and explained the purpose of the visit. Administrator Crystal Alegre arrived shortly thereafter.

Per the Special Incident Report (SIR), C1 was found unresponsive on a recliner in the living room on 8/14/2024 at 6:30 PM, and pronounced deceased by paramedics once they arrived at the facility.

During today's visit LPA interviewed the administrator Crystal Alegre, and during the interview Crystal explained that on 8/14/2024, C1 was sitting on a recliner in the living room awake and alert, and displayed no signs of illness. Staff checked on C1 after fifteen (15) minutes, and discovered that C1 was unresponsive and had no pulse. Staff proceeded to perform CPR on C1 and called 911 while also following their instructions. Once paramedics arrived, they declared C1 deceased at the home. Crystal stated that C1 displayed no signs of illness previously, and that at the time there was no suspected cause of death. Crystal also stated that C1 was diagnosed with a leaking heart valve, which may have contributed to C1's passing.

During the visit, administrator provided the LPA C1's Physician's Report, FACE Sheet, Appraisal/Needs and Services Plan, and their Medication Administration Records (MARs) for the past three (3) months. Administrator Crystal Alegre explained that she will email LPA a copy C1's death certificate once it becomes available.

LPA conducted a health and safety check of the facility, including a tour of C1's bedroom. No concerns, obstructions, or anything out of the ordinary was witnessed during the visit.

No deficiencies were observed during today's visit. Exit interview was held and a copy of the report was provided to the administrator Crystal Alegre.