Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management to follow-up on an Unusual Incident Report received in the Regional Office. LPA was greeted and granted entry by Concierge and met with Samuel De Guzman, Regional Operations Specialist (ROS).

LPA obtained the following documents for Resident #1 (R1): Face Sheet, Identification and Emergency Information, Medical Assessment dated 2/25/2026, Resident Appraisal, Resident Assessment dated 3/15/2026 and R1's Individualized Service Plan dated 3/15/2026. LPA also obtained R1's Advanced Health Care Directive. Advanced Directive, signed by R1, requested all treatments, other than those needed to be kept comfortable, be discontinued. The Regional Office received a Death Report from the facility on 6/2/2026. R1 passed away on May 26, 2026.

LPA interviewed Health and Services Director (HSD) and Resident Care Coordinator (RCC) regarding a Death Report received in the Regional Office on June 2, 2026. Resident #1 (R1) moved into the community on May 1, 2021. Per HSD and RCC, resident was declining and was being seen by the Primary Care Physician for a Urinary Tract Infection for the past month. Power of Attorney (POA) was aware. R1 was not on hospice but staff had notified POA that R1 had a change of condition and were discussing different care options when R1 passed away. Paramedics and Fullerton Police Department stated R1's passing was natural and did not need to be referred to the Coroner's Office.

Based on LPA's file review and interviews during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Samuel De Guzman, ROS and a copy of the report and LIC 811 were given at the time of the visit.