Facility Evaluation Report

On 06/10/2026 at 4:30 PM, Licensing Program Analysts (LPAs) L. Alexander and Y. Brown arrived unannounced to conduct a Case Management visit regarding an incident report received by the Community Care Licensing Division (CCLD) on 02/11/2026. LPAs met with General Manager, Linda L. Fisher, and explained the purpose of the visit.

CCLD received a Death Report on 02/11/2026 indicating that Resident (R1) was found unresponsive after an earlier wellness check by facility caregivers. LPAs interviewed Staff (S1), who stated that caregivers had observed R1 breathing during an earlier check and, upon returning to R1's room later, found R1 unresponsive. S1 stated that 911 was called and that Emergency Medical Technicians (EMTs) and the Pleasant Hill Police Department responded to the facility. S1 further stated that EMTs pronounced R1 deceased at the scene.

LPAs requested copies of R1's Physician's Report, POLST, Appraisal/Needs and Services Plan, Emergency Identification and Information form, and a copy of the death certificate. The facility was instructed to submit the requested documents to CCLD upon receipt of the death certificate from R1's family.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report was provided to the facility representative.