Incident investigation·November 3, 2021

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a Case Management visit. LPA met with Administrator Shelly Yarborough and explained the purpose of the visit. The purpose of the visit is to obtain additional information regarding a Death Report that was received 11/2/21. The facility also self reported R1's death via telephone call to LPA on 11/2/21. During todays visit, LPA interviewed Administrator and staff (S1). LPA obtained records from Resident's (R1) file. Administrator agrees to submit the following to LPA by 5PM today: Hospital report (from PCP), S1's internal/facility Incident Report, R1's vitals log dates 10/29 - 10/31/21 and R1's list of medications. There are no deficiencies cited during this visit