Facility Evaluation Report

Licensing Program Analyst (LPA) Nune Margaryan conducted a case management visit for the above facility to obtain additional information regarding an incident report received on 10/21/25 regarding Resident #1 who committed suicide on the same day in their room. Resident #1 resided in apartment 321. The resident was found by Physician’s assistant (PA) and Staff 1 (S1) on their bed non-responsive. 911 was called immediately. Family / POA was notified and arrived around 9:20 am.

West Covina Fire Department (WCFD) responded and subsequently contacted West Covina Police Department (WCPD), who arrived and initiated an investigation. The apartment was secured. WCFD arrived at 9:00 am and WCPD arrived at 9:09 am. Case # 25-05708. Medical Examiner was called and arrived around 12:30 pm and body was removed, Case # 2025-16501.

LPA requested and obtained the following documents: Residents and Staff roster, R1’s Identification and Emergency Information sheet, Admission Assessment, Physician’s Report, Medication list, Capability Evaluation - Results and Service Plan, Incident Report, Death Report, POA information.

Exit interview was conducted and a copy of this report was given to Administrator.