Facility Evaluation Report

At approximately 2:45PM, Licensing Program Analysts (LPAs) Felias and Deniz arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, Sherry Zhu. The purpose of the visit was to follow up a death report that was submitted to Community Care Licensing (CCL).

Death Report 1: CCL received a death report on 03/10/2025. Report states that Client 1 (C1) was taking a walk with facility staff and suddenly collapsed. Facility staff contacted emergency personnel. Facility made all appropriate notifications per regulation.

LPAs obtained additional documentation related to the incident. Facility to submit a copy of the Death Certificate to CCL when available.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.