Facility Evaluation Report
Capacity5
Census4
Date signed07/31/2024 02:56:05 PM
On 7/31/2024 at 1:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit in regards to death report received on 6/30/2024. LPA met with Interim Administrator, Adrian Yanga and explained the purpose of the visit.
LPA received death report on 6/30/2024 for client (C1). Death report revealed that C1 passed away on 6/29/2024 due to Acute Respiratory Failure. C1 was under hospice care.
LPA interviewed 1 staff and obtained documents (C1's care notes). C1 was admitted to hospice care on 6/18/2024.
No deficiencies is being cited on this date.
Exit interview conducted. A copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction