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25 | Licensing Program Analyst (LPA) Chavez conducted a subsequent case management visit to deliver findings for an incident reported by the facility on 12/11/22. LPA met with Carolyn Stewart, LVN, and explained the reason for the visit.
On 12/11/2022, the administrator emailed an Unusual Incident/Injury Report (LIC 624) to Community Care Licensing (CCL). The Incident Report stated that on 12/11/2022 at 4:25pm, staff entered the room of Resident #1 (R1) and found R1 in their bed unresponsive. Paramedics were called, and per the Administrator, R1 had committed suicide.
On 12/13/2022, from 10:36am to 1:00pm, LPA Chavez conducted an unannounced visit to the facility to investigate the incident reported by the facility. LPA met with Kirk Klotthor, Administrator, and explained the purpose of the visit. From 10:40am to 11:50am, the LPA toured R1’s room, conducted interviews with Administrator and staff, and requested documents pertinent to the investigation. LPA determined further investigation was needed. On 12/14/2022, the case was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Maria Barragan.
Investigator Barragan conducted interviews on 12/15/2022, at approximately 3:22pm, with Detective Dustin Phillips of the San Luis Obispo (SLO) Coroner’s office; on 12/19/2022, at approximately 4:08pm. and on 12/21/2022, at approximately 11:03am, contact with Lieutenant Chad Pfarr of the SLO Police Department; on 01/04/2023, at approximately 9:04am, with R1’s resident representative; on 01/12/2023, from approximately 10:40am to 1:55pm, with the Executive Director/Administrator, facility Licensed Vocational Nurse (LVN), staff and residents; on 01/17/2023, at approximately 1:01pm, with the SLO Long Term Care Ombudsman (LTCO); on 01/23/2023, from approximately 5:34pm to 5:55pm, with staff; on 02/05/2023,
Continued on 809-C. |