Follow-up·August 23, 2023

On 08/23/23, Licensing Program Analyst, Wendy Gibbs, conducted an unannounced case management visit to follow up on the death report of Resident 1 (R1). LPA Gibbs met with Administrator, Sandra Lopez, and explained the purpose of today's visit. The Regional Office received a copy of the death report from the facility who reported the death on 08/22/23 at 10:48am. The death report stated that during lunch on 08/14/23 at 12:20pm, in the dining room, R1 began to choke on a piece of hot dog. Staff 1 (S1) began to do the Heimlich Maneuver. The LVN (S2) on duty came to assist by continuing the Heimlich Maneuver and then giving CPR. Paramedics arrived at the facility, took over CPR, and at 12:45 transported R1 to the hospital. On 08/19/23 at 8:42pm, the resident died at the hospital. The Administrator was notified on 08/21/23 by the R1's Public Guardian. On the death report, submitted by the facility, the cause of death is due to complications from choking incident. R1's Public Guardian requested the medical records from the hospital and the Administrator is awaiting the records. Administrator stated they will send the medical records and death certificate to CCL when they receive them. During today's visit LPA Gibbs and Administrator toured the facility. LPA Gibbs received and reviewed the following documents: -Identification & Emergency Information -Penn Mar Healthcare Center (PMHC) Interdisciplinary -Preplacement Appraisal Information Discharge Summary -Physician's Report -PMHC Notice of Transfer/Discharge -Appraisal/Needs & Services Plan -PMHC Patient Information Sheet & Administrative Information -MAR -PMHC Nursing Services, Medication Consent & MAR -Patient Vital Sign/Diabetic Flow Sheet -PMHC Insulin Sliding Scale -Regular Insulin Sliding Scale AC Breakfast -PMHC Rehabilitation/Recreation Therapy -Special Incident Report -Facility Menu No deficiencies were observed or cited during today's visit. An exit interview was conducted with Administrator, Sandra Lopez and a copy of this report was provided.