Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced Case Management Incident visit. LPA met with Care Giver Josefina Pasamba and explained the reason for the visit. The visit is in response to the death of Client 1 (C1), who passed away on 8/18/2023.

During the visit, LPA reviewed C1's file and obtained copies of the following: ID/emergency Information, Admission Agreement, Physician's reports, Inland Regional IPP, Progress/daily notes, Medication logs , medical appointments, and laboratory paperwork. LPA requested a copy of C1’s death certificate when it is made available.

LPA spoke to C1’s family on the telephone during today’s visit, LPA was provided the cause of death based on what they were told by the hospital.

During today's visit, no red flags were observed, and no deficiencies were cited regarding this incident.

An exit interview was conducted, and a copy of this report was provided to Care Giver Josefina Pasamba.