Incident investigation·July 28, 2021

Licensing Program Analyst (LPA) Crystal Colvin arrived to the facility unannounced for the purpose of following up on the passing of a resident (R1). LPA Colvin met with Licensee Rosalina Olah and informed her of the purpose of today's visit. During today's visit, LPA Colvin interviewed the Licensee regarding the events that lead up to R1's passing, reviewed R1's file including Power of Attorney Paperwork, and interviewed Administrator Marcus Olah via telephone. During review of R1's file, LPA Colvin observed a completed Death Report for R1, which was never received by Community Care Licensing (CCL). LPA Colvin inquired about if the Death Report was ever submitted, and both the Licensee and Administrator stated that they faxed it in. LPA Colvin followed up on what fax number they sent it to, and observed that there was a mistake and the facility faxed the report to CCL's phone number, and not the fax number. LPA Colvin pointed this mistake out to Licensee Rosalina and additionally provided her with CCL's correct fax number. An exit interview was conducted with Licensee Rosalina Olah where a copy of this report was provided.