Facility Evaluation Report

On 2/23/24 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 Rolando Bundalian. LPA spoke with staff and explained the purpose of the visit was to gather information surrounding the death of (C1).

On 2/14/24, CCLD received a copy of the death report from the facility staff who reported the death of (C1) on 2/11/24 at 11:53am. The death report stated that staff checked on (C1) and found him unresponsive. The initial investigation did not indicate the cause of death. Staff called 911 and paramedics were dispatched and determined that (C1) had passed away.

The following documents were requested and received:

· Physician Report for Community Care Facilities,

· Mental and Physical Health Intake Assessment

· Report from doctor’s appointment 1/15/24

No deficiencies were cited during this visit.

An exit interview was conducted with Rolando Bundalian and a hard copy was provided.