Incident investigation·January 15, 2025

On 1/15/2025 at 11:15 AM Licensing Program Analysts (LPAs) P.Manalo and L. Fontanilla conducted an unannounced Case Management visit regarding a self-reported incident. Health Services Director self-reported the incident on 01/13/2025. LPAs met with Health Services Director, Leslie Ibo, and explained the purpose of the visit. LPAs obtained the following documents such as R1's Physician's Report, Emergency ID Face Sheet, Physician's Fax Report Notification, Discharge Summary from 12/20/2024, Internal Progress Notes, Care Plan, Individualized Service Assessment, Medication Administration Record (MAR), Appraisal Needs and Services Plan, and Staff Schedule. LPAs requested a copy of the Death Certificate to be sent to CCLD on 02/15/2025. No deficiencies cited during visit. Exit interview was conducted with Health Services Director, and a copy of this report was provided.