Facility Evaluation Report

On February 3, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management visit to follow up on a incident that was reported by the facility. LPA met with supervisor, Arlene Ruiz and explained the purpose of today's visit.

On January 22, 2026, the facility reported an incident that happened on the same day, on January 22, 2026 at 11:05 am, resident #1 (R1) was sitting and eating lunch when staff #1 (S1) noticed R1 was sliding off the chair. S1 attended to R1 right away and staff #2 (S2) came to help. Subsequently, S1 and S2 noticed that R1 was choking and called for additional help from Staff #3 (S3) who performed Heimlich Maneuver on R1 with the assistance of Staff #4 (S4) while staff #5 (S5) was calling 911. The incident report indicated that staff members were performing CPR to R1 until 911 arrived. R1 was transferred to the hospital and passed away on January 24, 2026.

During today's visit, LPA interviewed the supervisor and collected documents.

This report is reviewed and discussed with the supervisor.