Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit for the purpose of conducting a health and safety check of clients in care. LPA was greeted and granted entry by staff and LPA met with Lesley Cuizon, Direct Support Professional and discussed the purpose of the visit.

An Unusual Incident Report for a client death was received in the Regional Office on September 3, 2025. Administrator (AD) Dante Benedicto called LPA at 7am to verbally report the death and submitted the Death Report later in the day.

LPA arrived when three of the four clients were attending Adult Day Program. LPA spoke with Client #2 (C2) and asked about C2's day at Day Program. At 3pm the three remaining clients returned to the facility. LPA interviewed four of four clients and conducted a health and safety check. All were present when C1 passed away.

LPA spoke with two of two staff who were present when Client #1 (C1)'s passed away and obtained documentation from C1's file. Documents obtained include: Identification and Emergency Information Form, Face Sheet, Physician's Report, Individual Program Plan (IPP), Medication Administration Record (MAR) and mortuary information. LPA asked staff questions regarding C1's death and completed the Department report. LPA also spoke with AD Benedicto via phone on September 3, 2025 while AD verbally reported to the Department.

An exit interview was conducted with Lesley Cuizon, Direct Support Professional and a copy of this report along with LIC 811 was left at the facility.