Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced initial case management visit regarding the death of client #1 (C1) which occurred on 12/10/24. LPA met with Administrator, Linda and explained the reason of the visit.

According to the death report dated 12/10/24, C1 deceased on 12/10/24 who was found death in bed in the morning by staff. The suspected cause of death was respiratory failure.

During today's visit, administrator was interviewed, C1's file was reviewed and obtained the following:

· C1's last medical visit, dated 11/26/24

· C1's Police's Report and Death Certificate. Due on 1/14/25

Administrator stated she may get the death certificate and coroner report from C1's regional center (San Gabriel Pomona) when available. Exit interview was conducted and a copy of LIC 809 Report was provided to administrator.