Incident investigation·February 6, 2025

02/04/2025 10:00 AM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with Resident Care Director Jay Tippens. Today’s visit is regarding a death report that was received by licensing on 01/28/2025. It was reported that on 01/24/2025 Resident 1 (R1) was showing signs of stomach pain by clenching their stomach, and R1 would not attend lunch. Staff called 911 to come to the facility and evaluate R1. EMS transported R1 to Oroville Hospital via ambulance. R1 was admitted for peritonitis and kidney failure and passed away at Oroville Hospital on 01/26/2025. During the investigation it was learned that during a home health visit the RN determined that R1 had a low heart rate. R1 was taken to their primary care doctor who ran labs and referred R1 to a specialist cardiologist. R1 saw the specialist for one visit and the specialist scheduled a follow-up visit. Before R1 attended the follow up visit they became acutely ill, were hospitalized and passed away in the hospital. No deficiencies were cited as a result of today’s visit. Exit interview conducted and a copy of the report was provided to with Resident Care Director Jay Tippens.