Incident investigation·June 12, 2024

Licensing Program Analyst (LPA) Kesha Lewis conducted a case management visit as a result of the incident that took place on May 5, 2024. LPA met by the Health and Well-ness Director. and explained the purpose of today's visit. The department received an incident report detailing that R1 had tarry stool and a decreased appetite. LPA obtained information from R1'S file including but not limited to R1'S physicians report, hospice notes and records and facility care notes. R1 was sent to the hospital on 5/4/2024 and later passed away on 05/10/2024. The department did not have a record of the facility reporting the death of R1 but the facility was able to provide a fax conformation that the LIC- 624A was faxed to the department on 05/16/2024 which is within the required reporting period. Exit interview and copy of report given.