Follow-up·October 16, 2025

Licensing Program Analysts (LPAs) Tena Herrera and Elena Mallett conducted an unannounced Case Management Visit to follow up on a Death Report that was emailed to the Department on 10/8/25. LPAs met with Mona Castro and explained the reason for the visit. The Department received a Death Report dated 10/8/25 indicating the following: On 8/7/25 R1 was found on the street by a bystander and was complaining of abdominal pain, 911 was called and R1 was admitted to the hospital at 8:37am and was observed at the hospital for further evaluation and treatment. R1 was coded blue at 8:37pm and expired at 9:26pm. The cause of death was not specified and Medical Records were forwarded to Administrator on 10/8/25. On 8/5/25 the Department received a Special Incident Report (SIR) that indicated the following: R1 was having a regular day on 8/2/25, had a televisit with psychiatrist at 9am and was observed near dining room before 11:30am but was noticed by staff to have missed lunch. At 11:57 S1 went to search for R1 and later at 1pm Administrator conducted a search with no luck in locating R1. Family, hospitals and local police were all notified. Per LPA Herrera’s review of SIR’s and communication with the case carrying LPA Mallett no further SIR’s with updates have been received to the department. On 10/10/25 LPA Mallett spoke with Administrator Mona Castro and it was confirmed that there had been a phone call received on 8/26/25 by the pharmacy stating that insurance declined medication payment due to R1 being deceased. Administrator also confirmed that on 9/15/25 a contact that handles Assisted Living Waivers contacted the facility and asked that a death report be filed. Administrator explained that there was a conversation with R1’s emergency contact where they stated that R1’s SSI funds for the month of September had not been accessed which further suggested R1 passed away. (Continued on LIC809-C) On 10/13/25 the department received the following documents from R1’s File: Admission Agreement, Physician Report dated 1/27/25, Appraisal Needs and Service Plan dated 4/2/25, Medication Administration Records (MAR) from May-August 2025, ID and Emergency Information dated 1/7/23. Per the Administrator having continued updates on the possible whereabouts of R1’s status and not updating or reporting to the department LPA’s will be issuing a citation for a failure to report. Details will be found on the LIC809-D page. During todays visit LPA’s conducted a tour of R1’s bedroom, there were no concerns, obstructions, or anything out of the ordinary witnessed. LPAs have also requested facility to obtain and provide Licensing with R1's Death Certificate upon receipt. An exit interview, copy of the report, appeal rights and copy of LIC9098-Proof of Correction were provided to the Administrator.