Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced visit to conclude the case management visit conducted on February 19, 2025. LPA Monter met with Administrator Fe Punzalan and stated the purpose of the visit. LPA Monter observed 0 residents and 2 staff members at the facility.

On February 18, 2025, the Department received an incident report stating resident R1 was eating breakfast with bite sized (about thumb sized) waffles with peanut butter and dime-sized beef hot dogs. Staff was supervising the residents while eating. At approximately 5:33AM, the facility staff noticed that R1 was grunting and was choking. The facility staff immediately performed Heimlich Maneuver and noted that some undigested food came out from his/her mouth. The facility staff called 911 and asked for assistance since there was bluish discoloration of his/her face and R1 became unresponsive. The facility staff performed CPR immediately. The 911 Operator instructed staff to continue CPR. The staff performed CPR until the paramedics arrived. At 5:40 AM and took over the scene, after few minutes. The paramedics transported the R1 to Kaiser Permanente San Jose for emergency treatment. ADM was informed that resident R1 had passed. ADM stated she was informed that R1 was pronounced dead at 6:30 AM.

On March 12, 2025, the Department interviewed Service Coordinator SC. SC stated R1’s diet did not include anything about his/her food having to be pureed or cut into small pieces.