Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to conduct a case management. LPA met with Administrator (AD) Jom Ison; and stated the purpose of this visit.

On December 12, 2021, AD Ison sent a report to Community Care Licensing Division (CCLD) Orange Office. The report stated that at 8:36 PM of December 11, 2021, emergency medical personnel arrived in the facility to assess Client 1. Paramedics pronounced Client 1 dead at 8:38 PM. The Orange County Sheriff's Deputy was also in the facility to follow up the case. Later that night, mortuary services was notified; and removed the body out of the facility.

For this visit, LPA conducted a tour of the facility. LPA observed four clients in care and five staff members on the floor. LPA toured the client's rooms and common areas. LPA did not observed immediate threat to the health and safety of the clients in care. LPA conducted interviews and did a file review. AD provided the LPA with working copy of the Death Certificate provided by the mortuary. The report stated that the immediate cause of death is cardiopulmonary arrest. AD agreed to follow up the official death certificate; and will provide Community Care Licensing Division once the document becomes available.

No citation was issued during this visit.

LPA Marin conducted an exit interview with AD Ison and copy of this report was left in the facility.