Facility Evaluation Report

Licensing Program Analysts (LPAs) Hannah Rodgers and Ramin Hashemi conducted an unannounced case management visit to conduct follow up regarding a self-reported incident of Resident #1 (R1) passing away on August 31, 2025 [ See LIC811 Confidential Name List for identification of select person identifiers used in this report] . LPAs were greeted by, identified themselves to, and explained the purpose of the visit with Manager Sarita Mendoza.

On September 2, 2025, the Department received an self-reported incident report that described that on August 31, 2025, R1 was found unresponsive and later pronounced deceased.

During today’s visit, LPAs conducted a health and safety check, observed residents in care, and reviewed facility records.

There were no deficiencies cited during today's visit. However, this incident may require further follow-up visits.

An exit interview was conducted with Manager Sarita Mendoza, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to.