Facility Evaluation Report

On 9-24-21 at 9:27am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct and conclude a case management on an incident that occurred on 8-18-21. LPA met with lead caregiver Vivian Gambol and explained the purpose of the visit. Administrator Marylyn Patascil was notified by phone by caregiver who gave permission for lead caregiver to sign in her absence. LPA conducted health and safety check to ensure Title 22 compliance. LPA was checked for temperature and COVID screening upon entry. There are currently 4 residents residing at facility. Two staff members were present. No sharp object or toxins accessible to residents in care. Outside area was secure and free of obstructions. LPA requested and reviewed the following documents on 8-31-21: Physician report for resident1 (R1), caregiver progress notes for R1, emergency contact form for R1, Individualized Program Plan (IPP) for R1, and facility emergency protocol procedures.

LPA conducted interviews with Staff2 (S2), and S3 at facility on 8-31-21. LPA conducted interview with Staff1 (S1) by phone on 8-31-21. LPA additionally completed review of incident report and death report for R1 on 8-31-21. LPA completed review of physician report, IPP, and facility care notes for R1 on 9-7-21. LPA interviewed case worker for R1 on 9-14-21. Based on interviews conducted and records reviewed, it was revealed that R1 was noticed by S2 and S3 to be experiencing a sudden decline in health. Care notes, death report, incident report and interviews revealed that upon noticing this health decline, 9-1-1 was called in less than one minute by staff. Interview with S2 and facility documentation revealed that 9-1-1 personnel arrived within 15 minutes to tend to R1. It was further revealed through interviews and facility documentation that R1’s vitals were normal upon 9-1-1 personnel’s arrival. Based on interviews conducted and records reviewed it is determined that staff conducted emergency protocols appropriately upon noticing the emergency need for R1 on 8-18-21 and reported the incident within appropriate regulatory time frames to the Department.

No deficiencies were observed, and the department has determined this case management to be closed at this time. An exit interview and a copy of this report was left with lead caregiver Vivian Gambol.