Incident investigation·May 5, 2021

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced case management virtual visit, due to the COVID-19 pandemic. LPA identified herself and stated the purpose of the visit to Executive Director Wes Lavender and to Resident Care Director Elizabeth Smith. The facility self-reported a death regarding Resident 1 (R1) to Community Care Licensing on April 14, 2021. During today's visit, LPA conducted a virtual health and safety check, interviewed the Executive Director and the Resident Care Director. LPA also requested copies of resident records and staff contact information. No deficiencies were cited. An exit interview was conducted with Executive Director Wes Lavender and Resident Care Director Elizabeth Smith, to whom a copy of this report, LIC811 Confidential Names list, and the Licensee/Appeal Rights (9058 01/16) were provided via e-mail. An electronic read receipt verifies receipt of these documents.