Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced visit to conclude the case management visit conducted on 11/03/2023. LPA Monter met with Administrator (ADM) Anita Dela Cruz and stated the purpose of the visit. LPA Monter observed 0 residents and 2 staff member at the facility. 3 Out of the 3 residents were at the day program during LPA's visit.

On November 2, 2023, the department received a death report and incident report stating resident R1 was unresponsive when he/she arrived from the day program on November 1, 2023 at approximately 1:52pm. Day program staff contacted 911 and R1 was taken to the emergency room. R1 subsequently passed away at the hospital.

Based on a review of R1’s physicians report, dated September 29, 2023, R1 is a resident with developmental disabilities and underlying health conditions. Based on review of R1’s Death Certificate, R1’s death was due to natural causes and there were no other significant conditions contributing to R1’s death.

No deficiencies were cited at this time as per California Code of Regulations, Title 22. This report was reviewed with Administrator Anita Dela Cruz and a copy of this report was provided.