Facility Evaluation Report

Licensing Program Analysts (LPAs) Albert Marin and Celine De Perio conducted an unannounced case management visit to this facility. LPAs met with Administrator Josie Teehankee and stated the purpose of this report.

On July 7, 2022, The Community Care Licensing Division (CCLD) Orange Office received an incident from the facility stating that Resident 1 had an incident in the facility. Emergency Medical Services (EMS) was activated. EMS came and attempted to resuscitate R1 . R1 passed away in the facility. Responsible party and hospice agency were notified.

On this visit, LPAs Marin and De Perio toured the facility; and observed five residents in care and three staff members on the floor. LPAs toured the facility and inspected the all resident's rooms and common areas. LPAs did file review and random interviews. LPA requested to take the facility files that included but not limited to admission agreement, physician report, needs and services plan, centrally stored medication log and hospice notes.

Due to time constraints, this visit will be completed at a later time.

LPAs Marin and De Perio conducted an exit interview with AD Teehankee; and copy of this report was left on the facility.