Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted a Unannounced Case Management (Incident) visit to the facility in response to the Death Report of client (C1). Administrator Benny Moreno was explained the purpose of the visit. The purpose of today's visit is to check on the health & safety of the clients in care.

Client (C1) died on 10/18/2021 and it was reported that the administrator received a call from the day program and notified that C1 had a seizure and had fall in the restroom, other client called for staff assistance and performed chest compressions and called 911. Paramedics and Law Enforcement pronounced C1 death at the scene. The The death report was submitted in person to Community Care Licensing (CCL) on 10/19/2021.

Du ring today's visit LPA interviewed another staff. Copies of the following documents were obtained:

LPA requested the facility obtain a copy of the death certificate and submit it to CCL. A copy of the "Death Certificate" will be provided to CCL once received.

No Deficiency was observed during the visit

An exit interview was conducted. A copy of the report was provided to Administrator Benny Moreno.