Facility Evaluation Report

On 4-2-24, Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced to conduct a case management visit regarding incidents which occurred on 3/30/24. LPA met with licensee TERESA, ODILLON STA and explained the purpose of the visit. LPA reviewed incident reports dated 3-30-24 and facility file documentation for resident (R1). LPA also conducted health and safety facility tour as part of this case management. Additionally, LPA interviewed licensee.

On 3-30-24, facility reported that R1 passed way. on 3/09/24, R1 was found at the facility and was waking up when prompted vitals were checked and were okay but 911 was called as precaution. R1 was sent to the hospital on 3/9/24 and was placed on comfort care on 3/21/24 and then passed away at the hospital 3-30-2024. on 3/18/24 R1 was wake and lucid when licensee visited the hospital video shown to LPA. Facility provided R1's 602 (physician's report), IPP and preplacement appraisal. R1 was in the ICU 3/9/24-3/21/24.

LPA conducted facility tour with licensee. LPA observed facility common areas, various resident rooms, kitchen area and hallways. Facility was observed by LPA to be clean and sanitary. Floors and walls were clean without prominent stains. Facility was observed to contain no foul odors. Food supply was adequate with 7 days of non-perishables and 2 days of perishable items in place. Fire extinguisher was full charged and dated 9-15-23. Room temperature was 71*F. Smoke alarms and carbon detectors are functioning properly. Current census is 3. No obstructions to fire exits noted during today's tour. As a result of today's case management visit, no deficiencies are being cited under Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report was given.

This matter is still under investigation.

Licensee will obtain death certificate from family when available and email to LPA Lewis.