Facility Evaluation Report
On 01/16/2026, Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management Incident visit regarding the unexpected death of client#1 (C1) on 01/07/2026, at 5:20pm. LPA Ramirez was greeted by Licensed Locational Nurse- Edward Velarde and explained the purpose of the visit.
On 01/08/2026, LPA Ramirez received an Incident Report regarding the unexpected death of C1. On 01/07/2026 at 4:08pm, staff observed C1 was not breathing, Facility registered nurse staff#1 (S1) assessed C1 and after auscultation, staff did not observe C1 had any vitals. Staff#2 (S2) contacted C1’s hospice nurse. Hospice nurse arrived at the facility and declared C1 deceased at 5:20pm.
During record review, LPA Ramirez observed Hospice admission intake records that indicated C1 was admitted into hospice care on 12/10/2025.
Staff agreed to send LPA Ramirez copy of C1’s Death Certificate once received. LPA Ramirez obtained copies of C1’ physician’s orders, hospice communication notes, hospice admission intake, Vendor Special Incident Report, Death Report (LIC 624A), Individual Program Plan (IPP), Face sheet and physician’s report. LPA Ramirez may return at a later time to gather more documents in regard to 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