Facility Evaluation Report

Licensing Program Analyst (LPA) Riza Alvarez conducted an unannounced Case Management - Incident visit. LPA was allowed entry by reception staff. Residential Support Manager Salvador Anton met with LPA, with whom LPA introduced herself and discussed the purpose of the visit.

Today's visit was in response to a client's death (C1) on 08/21/2023. The facility attempted to submit the Death Report with Special Incident Report to CCLD on the same day but transmission failed. During today's visit, LPA was presented with copies of the Death Report and Special Incident Report. (See LIC811 Confidential Names List for a description of C1.)

During today's visit, LPA performed a brief tour of the facility and welfare check on clients present, finding no safety concerns.

According to records and interviews, C1 was admitted into the facility in July 2017 with primary diagnoses of Down Syndrome, Mild ID, Dementia/Alzheimer's disease. C1 was placed under hospice care due to Alzheimer's disease in May 2019 and graduated in March 2023. On 06/24/2023, C1 was re-admitted into hospice care also due to Alzheimer's disease and was on hospice at the time of death.

No deficiencies were cited for C1's death. No other deficiencies were observed or cited during today's visit. Mr. Anton stated that a copy of the death certificate will be obtained by the facility and submitted to CCLD as soon as available.

An exit interview was conducted with Mr. Anton, to whom a copy of this report, LIC811 (Confidential Names List), and the Applicant/Licensee Rights (LIC9058 03/22) were provided at the conclusion of the visit.