Facility Evaluation Report
On 02/26/2026 at 2:00 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported death report. The facility sent in a death report on 02/23/2026. LPA met with Administrator, Rosalinda Amacan, and explained the purpose of the visit.
Death Report (LIC624A) indicated that on 02/22/2026, C1 passed away in the hospital due to cardiopulmonary arrest. C1 was hospitalized on 01/25/2026 for pleural effusion and was placed on comfort care on 02/17/2026. C1 was hospitalized until C1 passed away. Interview with ADM stated C1 was in and out of the hospital as of July 2025 due to chronic pleural effusion.
During the visit, LPA obtained and reviewed the following documents including but not limited to C1's physician report, appraisal needs and services plan, Physician Orders for Life-Sustaining Treatment (POLST), after visit summaries, physician fax report, discharge summaries, medical follow up report, and death report.
LPA will be requesting for a death certificate.
No deficiencies cited. Exit interview conducted and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction