Incident investigation·December 5, 2024

LPA Jensen arrived at facility unannounced to conduct a case management in relation to multiple death reports received. LPA Jensen met with Executive Director Theresa Pettapiece and explained the purpose of today's visit. LPA Jensen received multiple death reports for residents on hospice between the period of 11/2/24 and 11/9/24. LPA Jensen reviewed the Certificate of Death with physician attestation for resident 1 (R1) and immediate cause of death is listed as senile degeneration of the brain. LPA Jensen reviewed the Certificate of Death with physician attestation for resident 2 (R2) and immediate cause of death is listed as senile degeneration of the brain. The incident report or LIC 624A for R2 was sent to the Department on 11/7/24 and lists the date of death as 10/2/24. The death certificate lists the date of death as 11/2/24. There appears to have been a misprint on the LIC 624A sent to the Department and the reporting was in fact done in a timely manner. LPA Jensen reviewed the Certificate of Death with physician attestation for resident 3 (R3) and immediate cause of death is listed as Alzheimer's disease. LPA Jensen reviewed the Hospice Death Report Summary for R4 which lists the hospice diagnosis as senile degeneration of the brain and lists physical findings as no pulse or respirations, skin pale and cool. No deficiencies were observed. The reporting appears to be compliant. An exit interview was conducted and a copy of this report was provided.