Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced Case Management Visit to follow up on a Death Report faxed to the Department on 5/18/26. LPA met with Hannah Hanako and explained the reason for the visit. Administrator Agnes "Annette" Aguila was not present during the visit, however, LPA spoke with administrator via phone call.

The Department received a Death Report dated 5/18/26 indicating the following:

On 5/18/26 the department received a death report for C1 that detailed on 5/11/26 C1 began to behave differently, staff assessed C1 and noticed C1 was pail with lips turning blue, 911 was called immediately and CPR was performed until EMS arrived. EMS continued life supportive measures and were unable to resuscitate the client and C1 was pronounced deceased on 5/11/26 at 3:54pm. A copy of C1’s Physician Report was received

On 5/20/26 LPA conducted file review and printed copies of C1’s Special Incident Reports and received copies of the following documents via email. C1's Annual Individual Service Plan (IPP) dated 4/9/25, Quarterly IPP dated 3/25/26, Harbor Regional IPP dated 10/3/25, Special Incident Report, Medication Administration Records (MAR) for the past 3 months (January-March 2026), Face Sheet and Physicians Report dated 3/23/26.

During today’s visit LPA interviewed Administrator and S1 via phone calls and toured C1’s bedroom. There was nothing out of the ordinary observed.

LPA has requested facility to obtain and provide Licensing with C1's Death Certificate upon receipt.

No deficiencies were issued during today's visit.

Exit interview held and a copy of the report was emailed to Administrator ( aaguila@peoplescare.org )