Incident investigation·May 3, 2023

On 5/3/2023, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management visit to follow up on an incident that was reported by the facility. On 5/1/2023, facility reported resident #1 (R1) was admitted to a skilled nursing facility on 1/20/2023 and returned on 4/26/2023 at 5PM. On 4/27/2023 at 1:30AM, a caregiver provided care to R1 and at 2:30AM, the same caregiver witnessed R1 to be unresponsive. Caregiver notified a med tech who observed R1 to be pale with no pulse then proceeded with calling 911. At 3:10AM, R1 was pronounced by 911. At 10AM, R1 was picked up by Coroner and taken to the mortuary. During today's visit, LPA requested for documents; LIC 602, reappraisal, service plan, hospital records and facility documentation to be submitted to CCL by 5/4/2023. No deficiency cited today. This report is discussed and reviewed with sales director.