Facility Evaluation Report

Licensing Program Analyst (LPA) Abdoulaye Zerbo made an unannounced visit to conduct a case management visit to follow up on a client's death. LPA met with Administrator Yulisa Maya Villalobos and explained the purpose of today's visit. LPA toured the facility and did not observe any immediate health concerns or violations.

During the visit LPA reviewed and collected pertinent documentation such as: ID/Emergency information, Physicians report, IPP, CDER, and medication records. LPA also interviewed Facility staff members for further information in regards to the death of C1 and the events that led up to C1's death. C1's medications and MAR records were reviewed,

LPA inquired about the cause of the death. A death certificate has not been issued at this time. Additionally, the preliminary cause of death is reported to be due to cardiac arrest. LPA advised to send a copy of the death certificate to the regional office once received.

Administrator contacted Community Care Licensing via email to inform of the death on October 29, 2025 and by fax on October 29, 2025.

An exit interview was conducted, a copy of this report was provided to Administrator Yulisa Maya Villalobos