Facility Evaluation Report

On 4/11/2025 at 10:29am, Licensing Program Analysts (LPAs) Michael Bilger and Noel Wolf Petersen arrived unannounced to conduct a case management visit regarding a previous death of a resident. LPAs met with Administrator Adetayo Kokumo and explained the purpose of the visit. LPAs conducted interviews with administrator, Staff1 (S1), and reviewed facility file documentation including physician's report for resident1 (R1), R2, R3, R4, R5, hospital discharge paperwork, and death report dated 12-28-24.

Based on interviews and record reviews it was determined that on or about 12/12/2024 at approximately 10:00pm, R1 experienced a choking episode while laying in bed eating a piece of pineapple. Staff1 (S1) on duty observed R1 initially appearing pale, coughing, and vomiting. S1 then observed R1 to be choking and called 911. Based on interview conducted, S1 notified 911 within 10 minutes of initial discovery of above symptoms. On 12/28/24, Licensee was notified that R1 passed away and submitted death report to licensing on the same date. A review of R1's death certificate and hospital discharge paperwork revealed R1 passed away due to acute hypoxemic respiratory failure and aspiration pneumonia.

Based on interviews and additional documentation review, it was further revealed that R1 did not require any special diet or diet restrictions. This case management requires further review. LPA will return at a later time for completion. An exit interview was conducted with Administrator and a copy of this report was provided.