Incident investigation·November 30, 2021

Licensing Program Analyst's (LPA's) De Leon and Kontilas conducted a case management visit to the facility above regarding an email from the administrator reporting the death of a resident in care on 11/26/2021. LPA's met with Staff Christina Martinez, director of Enliven Memory Care at Maravilla and explained the purpose of the visit. Administrator Ruth Grande arrived around 12:30 pm to talk with LPA's. LPA Kontilas interviewed two staff at the facility regarding the death of the resident. LPA De Leon requested the following records for Resident 1 (R1): LIC. 602A Physicians Report, Appraisal Needs and Services Plan, Pre-Appraisal, Hospital /or Doctors records for visits or discharge, Staff notes, Centrally Stored Medication and Destruct Records, Medication Administration Records, Police Contact Information Case#/ Name/phone number, Enliven Sign in and out sheets for November, POA/Conservator records, Emergency Contact form, Enliven Resident Roster, Enliven Staff Roster with phone numbers, Enliven Staff Schedule for the week of November 21st-27th, Copy of Contract with Agency for staffing, Agency Contract Staff Schedule at Enliven for the week of November 21st-27th, List of Agency Contract staff names and phone numbers, Transfer associations for Agency Contract Staff. The facility has a contract with an agency to provide additional care givers for residents at the facility. The same agency also has contracts with residents and their responsible parties for companionship. Staff 1 (S1) has a contract for care giving with the facility and also has contracts with residents at the facility for companionship. S1 does provide help with feeding for some residents and therefore must be associated to work at the facility due to the fact that S1 provides some type of care and is alone with residents in care at the facility. LPA De Leon referred the death of the resident to Community Care Licensing Investigation Branch (IB) for further investigation. Exit interview conducted, deficiency cited, civil penalty assessed, copy of report and appeal rights emailed to Administrator.