Facility Evaluation Report

On January 8, 2026, Licensing Program Analyst (LPA) conducted a case management visit to follow-up on an incident report that was reported by facility. LPA met with the administrator and explained the purpose of today's visit.

On December 19, 2025, the facility report an incident that happened on December 18, 2025 concerning resident #1 (R1) who reported not feeling well while being assisted to the bathroom by staff #1 (S1). Subsequently, R1 kneeled down on the carpet, facility called 911 and when the paramedics arrived, they proceed with CPR and they were told by R1's responsible party that R1 was not to be resuscitated. R1 was pronounced deceased.

The facility also submitted a death report including R1's diagnosis but the immediate cause of death was not indicated

During today's meeting, LPA requested for a copy of R1's death certificate and the administrator stated that R1's family member does not have a copy of the death certificate and the administrator will provide a copy to CCL when available.

This report is reviewed and discussed with the administrator.