Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced Case Mangement-Incident to follow up on the Death Report for Resident#1 (R1) on 11/20/25. LPA arrived, was greeted by the receptionist, and met with the Assisted Living Director, explaining the reason for the visit. LPA requested copies of pertinent information which includes and not limited to LIC 500 and Resident Roster. LPA conducted a physical plan tour, to ensure health and safety of the residents are protected and are in compliance with Title 22 Regulations. Today's investigation consisted of interviews with 3 staff members, R1's family member, and record reviews.

LPA is unable to close out the investigation at this time. Additional information needed prior to concluding investigation. Assisted Living Director was advised and a copy of this report given.