Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced Case Management Visit to follow up on a Death Report received on 06/04/2025. LPA was met by LVN Mira Lopez and explained the purpose of the visit. Assistant Administrator Mary Gonzalez arrived shortly.

Licensing received an email to report death of Resident #1 (R1) on 06/05/2025.R1 was admitted to hospital on 05/20/2025 for rapid heart rate. Death occurred at UCI Los Alamitos Medical Center on 06/04/2025 at 2:50 AM.

On 05/19/2025 staff noticed that R1 had a poor appetite and a rapid heart rate. Primary physician was informed and requested orders. The next night PM nurse noticed R1 heart rate was still elevated and contacted Administrator who then contacted the family and ambulance. On 05/20/2025 R1 was admitted were R1 health declined and later passed away on 06/04/2025.

During today's visit LPA interviewed the Administrator. LPA also toured facility and R1's bedroom. No concerns, obstructions, or anything out of the ordinary was witnessed during the visit. Licensee had provided via email R1’s face sheet, physician's report, medication administration record (MAR), restricted health care plan, individual person plan, and special incident report (SIR) for hospitalization. LPA will also request facility to obtain and provide Licensing with R1's Death Certificate upon receipt if available.

No deficiencies observed during today's visit. Exit interview held and a copy of the report was provided to the facility.