Facility Evaluation Report
Capacity6
Census4
Date signed02/13/2025 05:11:58 PM
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management - incident visit and met with Administrator (ADM).
On 2/12/2025, the Department received a incident report regarding a resident R1's death. R1 was found unresponsive in the bathroom.
LPA interviewed ADM, 1 resident and 3 staff. All other clients went to day program.
LPA obtained R1's physician report, appraisal needs and service plan, Individual Program Plan.
Exit interview was conducted with ADM. The report was provided to ADM for review and signature. A copy of the report was provided to ADM.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction