Facility Evaluation Report

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Case Management Visit to follow up on a Death Report faxed to the Department on 02/14/2026. LPA met with the Administrator, Estefany Lopez and LPA explained the purpose for the visit. The administrator, Estefany Lopez assisted LPA with the visit.

It was reported to Community Care Licensing (CCL) received on 02/14/2026 from Pasa Alta Manor that on 02/14/2026, staff were notified by Client #1 (C1’s) roommate Client #2 (C2) woke up around 7:30am, C2 noticed that C1 was unresponsive in bed, prompting an immediate response from staff who went to room #46 at 7:31am and called 911. Pasadena Police Department and paramedics both arrived at 7:33am and confirmed C1 had passed away at 7:35am. Cause of death is unknown at this time.

During today's visit, LPA interviewed the Administrator. LPA obtained copies of C1's Identification and Emergency Information, Appraisal Needs and Services Plan, Physician's Report, Medication Administration Record (MAR) from December 2025 to February 2026, recent Medical Records, Special Incident Reports, and other pertinent documents.

LPA also toured C1's bedroom. No concerns, obstructions, or anything out of the ordinary was witnessed during the visit. LPA will also request facility to obtain and provide Licensing with C1's Death Certificate upon receipt if available.

It is determined that the Case Management visit will require further investigation. No deficiencies observed during today's visit. Exit interview was held and a copy of the report was provided to the Administrator, Estefany Lopez.