Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to conduct follow up regarding an incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit with Executive Director Kristel Johnson.

On 5/21/2025, the Department received an incident report from the facility that described that on 5/6/2025, Resident 1 (R1) was found unresponsive in their room by facility staff. Staff called 911 and performed CPR until emergency personnel arrived. Emergency personnel contacted a physician via telephone. R1 was pronounced dead by the physician over the phone. Law enforcement also responded to the facility in regards to the death.

During today’s visit, LPA observed residents in care, and reviewed and obtained copies of facility records. LPA Borunda requested a copy of R1's death certificate when it became available from Executive Director. Additional investigation may be needed following review of R1's death certificate.

No deficiencies were cited on today’s date. An exit interview was conducted with Executive Director Kristel Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).