Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced Case management Visit to follow up on a Death Report faxed to the Department on 11/07/2022. LPA was met by DSP Roselyn Ochoada and explained the reason for the visit. Shortly after, administrator Vennie O Sabillo arrived and assisted with the visit.

On 11/05/22, Client#1 (C1) was sent to hospital due to C1 threw up and was feeling nauseated. On 11/06/22, the administrator called the hospital to follow up C1's health condition and reported C1 was admitted to ICU due to decreasing oxygen saturation level. On 11/07/22, administrator received a call from the hospital and stated that C1 passed away at 7:27am.

During today's visit, LPA was provided with the following documents of C1:

Medication administration Sheet for Oct and Nov 2022.

C1 has no family members and San Gabriel Pomona Regional Center was contacted on 11/07/22

LPA advised Administrator to send a copy of the death certificate to Licensing when it becomes available.

No deficiencies were cited per California Code of Regulations, Title 22, Division 6 during this visit.

Exit Interview conducted and a copy of the report was provided to the administrator.