Facility Evaluation Report

On 07/27/26, Licensing Program Analyst (LPAs) Elena Mallett conducted an unannounced initial Case Management to follow up on a Death Report sent to the Monterey Park Regional Office Fax on 06/22/2026. LPA met with Assistant Administrator Gloria Gibson and explained the purpose of the visit. Administrator Brian Buenviaje joined the meeting shortly after.

The facility reported in the Death Report received by Licensing that on 06/18/2026 Resident 1 (R1) at 05:00 PM was found unresponsive by Staff 2 (S2) in resident's bathroom. S2 called fellow staff member Staff 3 (3). 911 was called and S3 performed CPR on R1. Emergency Responders arrived within four to five minutes and performed emergency procedures but were not able to revive R1.

During today's visit the investigation consisted of three staff interviews including the Administrator, interviews with R1's roommate and R1's family member. The following documents were collected: facility staff and resident rosters, S2 and S3 's CPR/First Aid cards, R1’s Face sheet, pre appraisal and reappraisal Needs and Service plan, Medicine log for March-June 2026 and a notes from R1's June doctor visit. Administrator to send LPA R1's doctor notes from March, April, May 2026 doctor's visit .The resident's room and bathroom were toured along with the common areas of the facility. No immediate health and safety concerns were observed.

Administrator Buenviaje needed to leave before the conclusion of the visit and authorized Assistant Administrator Gloria Gibson to assist with the remainder of the visit and sign the Licensing Report. Administrator did not have R1's death certificate. Contact information for R1's Responsible party was provided to LPA so LPA could obtain a copy of the death certificate.Exit interview was conducted with Assistant Administrator Gloria Gibson and a copy of LIC 809 report was provided.