Senior Care Records.

Facility Evaluation Report

Crow Canyon Residential Care IV, Pittsburg09/29/2022Licence 079200030

Capacity6
Census5
Date signed09/29/2022 01:38:52 PM
The inspector’s account

On 9/29/2022 at 12:30PM Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a case management visit to follow-up on a death report received by Community Care licensing. LPA met with Yolanda Vengco and explained the purpose of the visit. Administrator, Ruffy Yu, arrived at 12:58PM

R1 passed away on 9/21/2022 with an unknown cause of death. During today's visit LPA obtained additional information pertaining to R1's death:

Hospital discharge summary that includes medications

LPA requested from facility a copy of C1's death certificate and the Pittsburg Police Department case number.

LPA was informed by Administrator that C1's death certificate will be provided to

Exit interview conducted and a copy of this report provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction