Facility Evaluation Report

Licensing Program Analysts (LPAs) Andrew Martinez and Becky Mann conducted an unannounced Case Management visit at the facility to follow up on an Incident Report regarding the adult death of Resident #1 (R1)'s which occurred on 6/10/2026. LPAs introduced themselves and were granted entry by facility staff. Administrator/Licensee Marie Libed was contacted by staff to inform them of LPAs presence and Administrator arrived shortly after.

LPA spoke with the Administrator/Licensee Marie Libed to obtain additional information regarding the death and complete a health and safety check. LPAs reviewed R1’s facility file and obtained copies of the following documents: Resident Identification and Emergency Information, admission's agreement, physician's report, preplacement appraisal, individual service plan, centrally stored medication log, hospice records, and special incident report/death report.

LPAs toured the inside and outside of the facility and there were no imminent health or safety concerns observed at time of visit.

LPAs advised Administrator/Licensee Marie Libed to send a copy of the death certificate to Community Care Licensing Division (CCLD) San Bernardino Adult & Senior Care Regional Office as soon as it is available. Further investigation may be required depending on the cause of death.

No deficiencies were cited during the visit. An exit interview was conducted where this Facility Evaluation Report (LIC 809) was discussed and a copy provided to Administrator/Licensee Marie Libed.