Facility Evaluation Report
On 04/23/2026 at 10:00 AM, 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 04/22/2026. LPA met with Executive Director (ED), Beena Kumar, and explained the purpose of the visit.
Death Report (LIC624A) indicated that on 04/22/2026, Resident 1 (R1) was found unresponsive by S1. S1 and S2 called 911 and CPR was performed until arrival of paramedics.
During the visit, LPA reviewed and obtained the following documents included but not limited to facility’s incident report, facility's observation notes, resident's physician report, resident's assessment, and appraisal needs and services plan. LPA also conducted interviews with 6 staff members and ED.
LPA will be requesting for a death certificate and police report by 05/07/2026.
No deficiency cited during today’s visit.
Exit interview conducted and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction