Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit due to the death of Resident #1 on the morning of 3/10/23. The death of Resident #1 was reported to LPA Yee by Martha Bacon on 3/13/23 via telephone and a little later, followed up with an emailed copy of the Death Report (LIC624A) and requested documents. Today's visit was conducted with Martha Bacon, Administrator, who was advised of the reason for the visit.

On today's visit, LPA Yee conducted interviews with the Administrator at 12:18pm, Hector Gomez, Assistant Administrator at 1:31pm, Staff #1 at 1:53pm, toured the site of the accident at 11:54am and reviewed Resident's file at 2:10pm. Roommate was sleeping and could not be interviewed and would not be a credible witness.

Per information that was provided to LPA Yee by Martha Bacon, Administrator, she was the one that served breakfast to Resident #1 between 7:45am - 8am on 3/10/23. After breakfast, Resident #1 left the facility and headed north on

Vineland Avenue and approximately 150 feet away from the facility, was hit by a vehicle. Office staff were immediately made aware of an accident that had just occurred by the residents and a staff who lives in the area. No one was aware