Facility Evaluation Report
On 01/3/2026 at 3:00 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 01/14/2026. LPA met with Executive Director (ED), Gianni Amari, and explained the purpose of the visit.
Death Report (LIC624A) indicated that on 01/07/2026, R1's home health nurse observed R1 unresponsive and slow breathing. Death report indicated that the cause of death is unknown.
During the visit, LPA reviewed facility’s incident report/ communication log, physician’s report, admission agreement, Resident Health Identification Information, progress notes, physician notes, home health care visit forms, and R1's service plan. LPA interviewed ED and S1. Interview with ED revealed that R1 had a wound and was referred to home health services. Interview with both ED and S1 indicated that R1 was diagnosed with a stage III wound per home health nurse documentation
LPA will be requesting for a death certificate.
The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalties.
Exit interview conducted, Appeal Rights and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction