Facility Evaluation Report

On 7/24/25 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 Debra Davenport, Manager. LPA spoke with Debra and explained the purpose of the visit was to gather information surrounding the death of (C1).

The Officer on Duty received a copy of the death report from the facility listed above that reported the death of (C1) on 5/3/25 at 4:30 pm. The death report stated that approximately 4:30 pm on 5/3/25 (C1) was eating dinner, (chicken and tater tots), when he began to choke. S1 began to perform the heimlich maneuver. Once S2 arrived, he continued the Heimlich manuever and (S2) immediately called 911. The paramedics arrived and attempted to intubate C1, however, their attempts were unsuccessful.

· Physician Report for Community Care Facilities

· Westside Regional Center – Incident Report

· Gardena Police Department – Law Incident

No deficiencies were cited during this visit.

An exit interview was conducted with the Manager, Debra Davenport and a hard copy was provided.