Facility Evaluation Report

At approximately 11:00AM, Licensing Program Manager (LPM) Kimberley Mota and Licensing Program Analyst (LPA) Chris Arnhold met with Licensee Yolanda De Guzman and Acting Administrator Jean Rice in the Santa Rosa Regional Office to discuss a questionable death that occurred at the facility on 06/16/2025.

LPM and LPA discussed with Licensee and Acting Administrator the incident of 6/16/25 when Resident (R1) was found unresponsive by Staff (S1) and facility did not call 911. R1 was not on hospice. LPM discussed concerns if facility were to have an emergency and S1's ability to engage in their disaster plan. Acting Administrator admitted it was a mistake that S1 did not call 911.

A discussion was also held regarding R1 and the administration of their medication. Acting Administrator stated that when R1 refused medication, R1's family was notified and not R1's primary care physician.

Licensee and Acting Administrator were provided copies of Provider Informational Notice (PIN) 25-06-ASC, Regulation 87465, Incident Medical and Dental Care and Regulation 87469, Advanced Directives and Requests Regarding Resuscitative Measures for review.

LPA requested additional documentation for the appointment of Jean Rice as Administrator:

-Signed statement from Licensee appointing Administrator