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25 | On 11-23-21 at 3:25pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit for a death report received on 11-14-21. LPA spoke with Administrator Maria Cleotilde Brelin by phone and explained purpose of the visit. Administrator gave permission for Dominic Maata, facility manager to sign in her absence and accommodate LPA. LPA reviewed incident report submitted on 11-10-21 and death reported submitted on 11-14-21. Incident report was not immediately available for review but was furnished by Administrator along with fax confirmation to LPA during visit. According to death report, Resident1 (R1) was admitted on 10-15-21 and was sent to the hospital on 11-7-21. R1 then expired on 11-10-21.
Based on review of incident report and death report it was determined that Administrator called 911 on 11-7-21 after R1 experienced low blood pressure and non-responsiveness. Based on interview and review of incident report, responsible party was also notified of incident. Administrator then received information from hospital that resident expired on 11-10-21. Regional Office received incident report on 11-10-21 at 1:50pm. Facility met reporting requirements per Title 22 regulations.
No deficiencies cited as a result of today's visit. An exit interview was held with Dominic Maata and a copy of this report was left with Dominic.
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