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25 | On 12/13/22 at 9:15am, Licensing Program Analyst, (LPA) Perry Scott conducted a Case Management visit to follow up on the death reported for resident #1 (R1). LPA was greeted by Sherese Butler, house manager, and LPA explained the purpose of the visit was to gather information surrounding the death of (R1).
The regional office received a copy of the death report from the facility and reported the death of (R1) on 11/28/22. The death report stated that on 11/27/2022 at about 5:00am, R1 was found unresponsive. R1 was laying down on the couch in the living room next to W1 (DSP). R1’s skin was warm to the touch but R1 was not breathing. W1 started CPR and called 911 and dispatch stayed on the phone while W1 was doing CPR until the paramedics arrived. Paramedics arrived along with the sheriff’s department and they continued CPR on R1. At 6:45am R1 was pronounced dead by the deputies. The cause of death is unknown and under investigation. LPA requested a death certificate from the administrator once they receive it.
The following documents were requested:
ID and Emergency Information,
Admission Agreement
Physical Health Intake Assessment,
Physician Report
Pre-Admission Assessment.
Medications (MAR)
Food menu
Death Certificate
An exit interview was conducted with Sherese Butler and a hard copy was provided.
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