Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management visit regarding an incident report. LPA met with Administrator, Napoleon Francisco and explained the purpose of the visit.

On January 19, 2024, the Department received an incident report stating on January 18,2024, resident, R1 was found in another residents bedroom, lying down on his/her back, breathing heavily. While assisting R1, staff contacted 911. Staff then noticed R1 seemed not to be breathing anymore. The department was notified thru a subsequent incident report that R1 had passed away. The cause of death is unknown at this time

LPA requested R1's Progress Notes , R1's Identification and Emergency Information, San Andrea's Regional Center(SARC) schedule, functional capabilities, Appraisal needs and services plan, SARC IPP reports, R1's Behavioral consult/ Quarterly Report, Nutrition Assessment, LIC500.

This case management will be kept open pending investigation.

Exit interview was conducted with Administrator, Napoleon Francisco . A copy of this report was provided to Administrator, Napoleon Francisco .