Facility Evaluation Report

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit for the purpose of conducting a case management visit concerning a prior resident death. LPA met with Administrator, Melissa Sumibcay who was informed of the purpose of the visit.

At the time of the visit there were (4) staff and (1) resident present. LPA observed resident #1 (R1) was in their bedroom watching the television. Staff informed LPA other (3) residents were at their day program. LPA conducted a walk through of the facility and did not observe any health and safety issues. LPA observed the facility utilities were running with no issue, food supply is sufficient for (4) residents, and medications are at least a 30-day supply.

LPA conducted interviews with staff present, collected documentation and contact information for staff. LPA advised the administrator of documents that would need to be sent to LPA as soon as possible. The administrator was advised that at this time the department is still looking into the incident and the matter is an ongoing investigation.

Am exit interview was conducted were this report was reviewed and provided to Administrator, Melissa Sumibcay.