Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management and met with Licensee/Administrator Tony Guevarra. The purpose of this case management visit is to follow up on a death report received at Community Care Licensing (CCL) dated 04/22/26. Previously on 4/23/26 LPA have requested Death Certificate due to resident was not receiving hospice services when they unexpectedly passed away on 4/22/26.

According to death report, On 4/22/26 at approximately 7:00pm, staff (S1) found C1 lying on the ground behind their room on the back porch area. C1 was unresponsive, S1 immediately called 911, emergency responders arrived promptly, attempted to revive C1. Despite their efforts, C1 did not respond and was pronounced deceased at the scene. Responsible parties were notified.

During today's visit, LPA obtained C1's physician report, medication records and care plan.

No deficiencies cited during today's visit.

Exit interview conducted with Administrator and a copy of this report was given.