Facility Evaluation Report
On 11/20/2025, Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management Incident visit regarding the unexpected death of client#1 (C1) on 11/17/2025. LPA Ramirez was greeted by Awele Obuly and explained the purpose of the visit. LPA Ramirez toured facility and conducted wellness inspection.
On 11/18/2025, LPA Ramirez received an Incident Report regarding the unexpected death of C1 at the facility. According to Facility/Program Special Incident Report (SGPRC 641), on 11/17/2025 at 5:40 am, staff entered C1’s room and observed that C1 was not snoring as C1 normally did. Staff called out C1’s name and did not observe C1 respond. Staff called out C1’s name several times again and C1 did not respond. Staff called 911 and began CPR until paramedics arrived. Paramedics arrived within 8 minutes and took over life saving measures. At 6:10am, paramedics pronounced C1 deceased. West Covina police officer Salgado (Badge# 510) arrived to observe C1’s body and called C1’s family. At 11:40am, C1’s body was picked up by local funeral home.
LPA Ramirez requested a copy of C1's Death Certificate. LPA Ramirez obtained copies of C1’s face sheet, Death Report (LIC 624A), Medical Progress Notes from Central City Community Health Center dated 10/21/2025 and 08/19/2025, medical lab results dated 07/29/25, 08/19/25, centrally stored medications and destruction log, and medications administration record for 11/2025, 10/2025, 09/2025, and 08/2025 Individual Program Plan (IPP), and physician’s report.
LPA Ramirez may return later to gather additional documents regarding this visit.
No deficiencies were observed during this visit. Exit interview was conducted. A copy of this report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction