Facility Evaluation Report
Capacity4
Census3
Date signed07/22/2022 11:12:36 AM
On 7/22/2022 at 8:35AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit in regards to death report received on 7/14/2022. LPA met with Administrator, Sophia Tekle and explained the purpose of the visit.
LPA received death report on 7/14/2022 for client (C1). Death report revealed that C1 passed away at the hospital on 7/14/2022 due to urinary sepsis.
LPA interviewed 1 staff and obtained documents including C1's physician's report, MAR, communication with doctor, and care notes.
Exit interview conducted. A copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction