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25 | At 4:15 pm on this day, 1/23/25, Licensing Program Analyst (LPA) Delmundo arrived unannounced in response to the Unusual Incident Report (UIR) for resident (R1) submitted by the facility and received by LPA on 1/06/25. LPA also received a copy of the Death Report for R1 on 1/07/25. LPA met with staff, Randall Cabading and Nathaniel Anis, and informed the reason for visit. Randall Cabading called and have Marissa Legarda, administrator (ADM), speak with LPA. ADM arrived at around 4:38 pm followed by Rudy Golilao, assistant administrator.
UIR indicated that on 1/05/25, R1 arrived back to the home from their van ride. R1 went directly and sat down in R1's recliner to take rest. Approximately about after 10 minutes, staff (S1) noticed R1 slouched and passed out. S1 went to R1 to check and noticed R1's lips turned bluish. R1 was not responsive. The other staff (S2) called 9-1-1 and S2 was instructed over the phone to do CPR while waiting for the first responders to arrive. Hayward Fire Department paramedics arrived and took over the resuscitation. R1 was pronounced dead at around 2:15 pm. The paramedics informed the staff that they notified the Sheriff's Department. Sheriffs arrived and talked to the staff and called R1's sister. R1's sister decided to have R1's body picked-up by the funeral home.
LPA reviewed R1's file and conducted interviews. LPA obtained copies of including but not limited to the following R1's documents: Face Sheet; LIC601 Identification and Emergency Contact Information; LIC602 Physician's Report; Medication Administration Record; Monthly Behavior Data Sheet; facility notes; Individual Program Plan
No deficiency cited on this day.
Exit interview conducted and copy of this report provided. |