Facility Evaluation Report

Licensing Program Analyst (LPA) Kennedy conducted a case management visit to complete a review regarding a self-reported death of Client 1 (C1) (See LIC 811 for confidential names) received by CCL on 12-8-21. LPA met with Emma Manalo, House Manager and discussed the purpose of the visit.

LPA reviewed C1's facility file toured the facility, interacted with clients and interviewed staff about events leading up to the death. C1 resided at the facility since 11-17-17. On 12-3-21 C1 complained of abdominal pain and was vomiting. 911 was called and C1 was sent to the hospital. C1 was transferred to another hospital on 12-4-21 where she became unresponsive and given a diagnosis and a prognosis of eminent death. The family made end of life decisions and C1 passed away on 12-8-21. The death of C1's was relatively sudden with only five days between onset of symptoms, hospitalization and death, however the death was expected.

No deficiencies were cited during the visit.

An exit interview was conducted with Emma Manalo, House Manager. A copy of this report was provided to the administrator via email. An electronic response confirms the documents were received. Licensee Rights (LIC9058 01/2016) were left at the facility.