Incident investigation·August 9, 2022

***AMENDED - Licensing Program Analyst (LPA) Cuadra arrived unannounced for the purpose of amending a case management report dated 8/9/2022 and citation issued the same date. The document requires amending because citation #80061(a)(1)(A) was issued in error by LPA and the amended document deletes reference to citation. LPA removed the citation in LIC809D as well. Licensing Program Analyst (LPA) Cuadra conducted an unannounced Case Management visit to this facility was greeted by staff, Robertson Cirineo who is the designated person on file to sign the report. LPA arrived at the facility and had their temperature checked and logged into a sign-in sheet. On 8/2/22 CCL received a SIR from Licensee Josephine Credo notifying CCl about resident (R1) who on 7/30/22 around 1:30am was noted by NOC staff while conducting their round check, resident was having shortness of breath and looking very pale, staff tried to waking up but R1 was not responding, their oxygen level was checked and it was very low between 60-79, 911 was called immediately, their responsible party (POA) was notified and resident was transported to the Hospital. POA called the Administrator to notify her that resident was not doing well, they couldn't insert any IV fluids due to having issues to find a good vain, R1 was declining very quickly due to respiratory and organ failure, it was decided to put resident on comfort care. On 8/3/22 LPA received a death report notifying CCL that R1 passed away on 7/31/22 around 7:45am. Per Licensee, they were notified by POA/conservator agreed that they will provide the death certificate to Licensee. However, death report was received at CCL 3 days later and not within 24 hours as stated in regulation. During today's visit, LPA confirmed with staff that R1 passed away on 7/31/22 and the facility did not notify to licensing agency within the agency's next working day during its normal business hours. No deficiencies cited during today's inspection.