Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent case management visit in response to an initial case management dated 10/16/25 following the death of Client #1 (C1), who passed away 10/10/25. LPA met with Administrator Magdy Tawfik and explained the purpose for todays visit.

On 10/13/25 the Department received a Death Report indicating the following: On 10/10/25 C1 was observed to grab items from the kitchen that appeared to be food, placed it in their mouth and began to run away. S1 followed them and saw C1 fall in front of their bedroom. S1 tried to remove as much food out of C1’s mouth as possible, struck C1 on the shoulder blades and administered abdominal thrusts. S2 called 911 and the fire department arrived in attempt to save C1’s life but there was no success and C1 was declared deceased at 10:40pm.

On 10/15/25 LPA Herrera received copies via email, of the following documents from C1’s file: Death Report, Medical Progress Note dated 9/8/25, Psychiatry Progress Note dated 9/12/25, South Central Regional Center Individual Program Plan dated 2/24/23, ID and Emergency Information, Medication Administration Record (MAR) for Sept-Oct 2025, Annual Behavioral Report dated 8/18/25 and a copy of the Death Certificate “working copy” dated 10/15/2025. C1's most current Appraisal/Needs and Services Plan, and Hospice Notification.

On 10/16/25 LPA conducted an initial case management visit and toured C1's bedroom. No concerns, obstructions, or anything out of the ordinary was witnessed. LPA requested facility to obtain and provide Licensing with C1's Death Certificate (finalized, signed by physician and without the words working copy) upon receipt.

On 12/10/25 LPA received a copy of C1’s finalized Death Certificate with the cause of death listed as: Cardio Respiratory Failure, Acute Arrhythmia, Acute Myocardial Infraction, Coronary Artery Disease .

Based on statements and interviews conducted with staff and review of C1's files and death report the cause of death does not appear to be suspicious or due to any neglect, therefore the findings are UNSUBSTANTIATED . Exit interview held, and a copy of this report was provided.