Facility Evaluation Report

164th Place, INC., Gardena02/22/2024Licence 198320080

Capacity4
Census3
Date signed02/22/2024 02:26:13 PM
The inspector’s account

On 2/22/24 Licensing Program Analyst (LPA) Felisa Shirley conducted a Case Management visit to follow up on the death reported for Client #1 (C1). LPA was greeted by Claudia Lujon. LPA spoke with Claudia and explained the purpose of the visit was to gather information surrounding the death of (C1).

On 2/15/24, LPA Shirley received a copy of the death report from the facility staff who reported the death of (C1) on 2/15/24 at 5pm. The death report stated that approximately 5:00pm on 2/15/24 (C1) died of Cardiac failure. Byron was under the care of his physicians for cardio pulmonary care. John will email the following:

No deficiencies were cited during this visit.

An exit interview was conducted with Suyono Wong, (John) and a hard copy was provided.

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