Incident investigation·March 24, 2023

At approximately 9:10AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Incident Visit and met with Executive Director/Administrator, Ricardo Romero. The purpose of the visit was to follow up on self-reported incidents that were submitted to Community Care Licensing (CCL). LPA reviewed the following reports with Executive Director: Death Report: CCL received a death report on 03/01/2023. The report states that on 2/22/2023, Resident 1 (R1) was found unresponsive by care staff. Per report, R1 was not on hospice, but had a decline in health after their last visit to the hospital. Facility made all appropriate notifications per regulation. LPA discussed R1 with Executive Director. Per conversation with Executive Director, R1 resided in Assisted Living but was very independent. Prior to their death, R1 was observed to be happy, but had a rapid decline in overall mobility and health. Executive Director stated that the Coroner reported to the facility that R1's death was from natural causes. Facility will be submitting a copy of R1's Death Certificate to CCL when it is available. Incident Report: CCL received an incident report on 03/03/2023. The report states that on 02/25/2023, Resident 2 (R2) expressed to staff that they were having a difficult time mentally. Report also states that R2 wanted to kill themselves. Facility made all appropriate notifications per regulation. LPA discussed R2 with Executive Director. Per conversation with Executive Director, R2's spouse had a decline in health and R2 was having a difficult time. Facility provided a one-on-one companion for R2, social worker support, and chaplain services. Facility and family discussed updating R2's care plan to include scheduled checks. As of 3/24/2023, R2 is continuing to be on frequent checks. Facility has continued to work with R2's family and the chaplain to provide additional support and services. LPA conducted a walkthrough with Executive Director/Administrator. No Deficiencies cited during visit. Exit interview conducted. Copy of report and LIC 811 (Confidential Names) discussed and provided to Administrator. Signature on form confirms receipt of documents.