Facility Evaluation Report

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz made an unannounced Case Management- Incident inspection visit to the facility. LPA Quiroz was greeted and granted entry into the facility by Direct Service Provider (DSP 1). House Manager (HM) Tani Oshodi arrived shortly after and explained the reason for the visit. LPA Quiroz, along with HM Oshodi conducted a tour of interior and exterior of facility premises.

The purpose of today’s visit is to follow up on an investigation conducted by the Department. The investigation conducted revealed the following:

On 5/01/2021, Client 1 (C1) moved into the facility. C1’s physician report May 27, 2021 lists in part that C1 had a diagnosis of: Profound intellectual disability, total blindness, Autism, and Type II Diabetes. On the evening of 8/21/2021, C1 was given dinner and their medications at approximately 7 pm , before going to bed. At around midnight, the House Manager (HM) checked to see if C1 required assistance with incontinence care. Upon further evaluation, the HM observed C1 was unresponsive and noted to not have a pulse. The HM immediately called 911 and was instructed to perform chest compressions, which were conducted. At approximately 0455 hours, paramedics arrived and C1 was pronounced deceased.

The Brea Police Homicide Department responded to the facility to investigate. Reports from the Orange County Sheriff-Coroner concluded C1’s time of death to be approximately 1:30 pm on 8/21/2021. The investigation revealed, that HM called the paramedics timely after finding C1 unresponsive in bed. Facility staff had notified C1’s Primary Care Physician Dr.Patel that C1 appeared to be weaker based on their observations. Staff reported C1 did not complaint about not feeling well and did not display any symptoms indicating they were sick. Continued on next page...