Facility Evaluation Report

Licensing Program Analyst (LPA), Kathrina Chin made an unannounced site visit for the purpose of a case management- death report follow up and to check on the health and safety of residents in care. LPA Chin identified herself and met with Jordan Cervantes, RN.

LPA, Kathrina Chin spoke to Jordan Cervantes, RN regarding resident 1. RN stated that resident passed away at the facility on 6/3/22 at 11:58 PM.

Jordan Cervantes stated that on June 3, 2022, resident 1's vital signs was low, turning gray in color and foaming in the mouth. Staff dialed immediately 911 emergency personnel at 11:15 PM. The paramedics conducted CPR upon arrival at the facility. Resident passed away at 11:58 PM. Resident was in the hospital from May 7, 2022 and was discharged on June 3, 2022. Resident re-admitted at the facility 5:45 PM and Jordan Cervantes, RN conducted an assessment upon re-admission. The RN stated that resident had edema, lungs were congested, and placed him on an oxygen concentrator. RN stated that she reviewed discharge documents. RN called the Nurse Practitioner and communicated her concerns. NP stated that he was coming the following day. RN stated that she observed the resident's body to swollen all over and stomach was distended and hard. There was a plan to get a chest X- ray. The chest X - ray company was completed on the same day around 9:51 PM. Resident returned from the hospital without any medications other than the supplies for the wound care for the J-tube and G-tube. RN spoke to the consulting Nutritionist and a recommendation was provided. The Nutritionist reported that she was coming on 6/8/2022. LPA requested a copy of the physician's report, IPP, Needs and Services Plan, medication list and hospital discharge documents.

No deficiency cited during this review as per Title 22 of the California Code of Regulations.

An exit interview was conducted with Jordan Cervantes, RN and a copy of this report was provided to Jordan Cervantes, RN.