Follow-up·March 19, 2024

Licensing Program Analysts (LPAs) Bennette Pena and Christian Gutierrez conducted an unannounced Case Management Visit to follow up on the Death Report of a Resident faxed to the Department on 03/16/2024. LPAs were met by Alexander Solorio, Assistant Administrator and explained the reason for the visit. Facility reported that around 6:30am on 03/12/2024, a staff noticed the resident/R1 (Robert Polinsky DOB 10/22/1969) sleeping. At around 9am, a staff was conducting med rounds and found R1 unresponsive and had no pulse. The staff called 911, paramedics arrived, checked R1's pulse and declared R1’s time of death at 9:07am. The cause of death is yet to be determined, awaiting autopsy from mortuary as indicated in the death report submitted by the facility. During today's visit LPAs interviewed the Asst. Administrator/S1. S1 stated that he received a call from a staff on Tue., 3/12/2024 regarding R1 who was unresponsive. S1 instructed the staff to call 911 immediately. Paramedics arrived and checked R1's pulse and declared him dead. Pasadena Police came and interviewed the staff members present. Prior to today’s visit, LPA Pena obtained copies of Staff and Resident rosters, House Rules, R1’s files such as Face Sheet, Death Report, Admission Agreement, Appraisal/Needs & Services Plan, Physician's Report, Medication Administration Record (MAR) for Jan 2024-Mar 2024, and Pasadena Police Report information (24-19553). No concerns, obstructions, or anything out of the ordinary was witnessed during the visit. LPAs also re quested the facility to obtain and provide Licensing with R1’s Death Certificate upon receipt if available. Deficiency observed during today's visit and cited on LIC809-D. An exit interview was held and a copy of the report was provided to Alexander Solorio, Administrator.