Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Parks arrived on November 12, 2025 to conduct a case management due to a death report submitted to the Department on 10/13/2025.

R1 moved in to the facility on 9/10/25. R1 was diagnosed with Dementia. R1 required medication management, and was taking 2 medications daily. R1 required assistance with bathing, dressing, grooming, and incontinence care.

On 10/6/2025, R1 ate minimal breakfast. Per R1's routine, they sit in a recliner in the living room after meals. R1 was regularly observed by staff. When staff were trying to help R1 to the dining room for lunch, staff observed R1 was unresponsive. Staff called 911. 911 attempted to revive R1 but were unsuccessful.

LPA obtained a copy of R1's physicians report. Administrator requested a copy of the death certificate from the family, when it is available. Administrator will then provide LPA with a copy of the death certificate.

Exit interview conducted. A copy of this report was provided to the facility.