Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent case management visit in response to an initial case management dated 10/16/25 following the death of Resident #1 (R1), who passed away 8/7/25. LPA met with Licensee/ Administrator Mona Castro and explained the purpose for todays visit.

On 10/8/25 the Department received a Death Report indicating the following: on 8/7/25 R1 was found on the street by a bystander and was complaining of abdominal pain, 911 was called and R1 was admitted to the hospital at 8:37am and was observed at the hospital for further evaluation and treatment. R1 was coded blue at 8:37pm and expired at 9:26pm. The cause of death was not specified, and Medical Records were forwarded to Administrator on 10/8/25.

On 10/10/25 LPA Mallett conducted a telephone interview with Administrator Mona Castro .

On 10/13/25 the department received the following documents from R1’s File via email: Admission Agreement, Physician Report dated 1/27/25, Appraisal Needs and Service Plan dated 4/2/25, Medication Administration Records (MAR) from May-August 2025, ID and Emergency Information dated 1/7/23.

On 10/16/25 LPA’s Herrera and Mallett conducted an initial visit, conducted interview with Administrator, toured R1’s room and requested facility to obtain and provide Licensing with R1's Death Certificate upon receipt.

On 1/14/26 LPA Herrera received a copy of R1’s Death Certificate dated 11/25/25 with the cause of death listed as: Congestive Heart Failure .

Based on statements and interviews conducted with staff and review of R1's files and death report the cause of death does not appear to be suspicious or due to any neglect, therefore the findings are UNSUBSTANTIATED . Exit interview held, and a copy of this report was provided.