Facility Evaluation Report

Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to conduct a case management visit to follow up on information that was reported to the Department regarding a resident death. LPA met with Medical Technician Liliana Valenzuela, and explained the purpose of today's visit, and toured the facility. Administrator Heather Scott arrived during the visit.

The visit is in response to the death of Resident #1 (R1), who passed away approximately on 10/17/2022 at an undetermined time.

During LPA's visit, LPA reviewed R1's file and obtained copies of the following: ID/emergency Information, Physician's reports, resident appraisal, medication records (MARs) for the month of 10/2022, and Hospice records. LPA also requested a copy of R1s death certificate when it is made available.

During today's visit, no deficiencies were cited in regard to this incident.

An exit interview was conducted, and a copy of this report was provided to Administrator Heather Scott.