Facility Evaluation Report

Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent case management visit to deliver findings for the questionable death investigation initiated on 09/05/2024 case management visit. LPA met with Administrator Victor Hernandez and Assistant Administrator Celesty Hernandez and explained the reason for the visit.

On 08/30/2024, the Woodland Hills North Adult & Senior Care Regional Office received a death report which stated Resident #1 (R1) was hospitalized on 08/17/2024, diagnosed with a urinary tract infection (UTI), and passed away on 08/30/2024 while at the hospital. The case was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Christine Ferris.

On 09/05/2024, from 2:30pm to 4:30pm, Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management – Incident visit to the above facility. LPA Cortez met with Administrator Victor Hernandez and assistant Administrator Celesty Hernandez and explained the reason for the visit. The Administrator had to leave during the visit and designated the assistant Administrator to review and sign the report. The reason for the visit was to follow up on a self-reported death report received on 08/30/2024. The report pertained to the death of Resident #1 (R1). Per the information received, the circumstances surrounding the death of R1 on 08/30/2024 may be questionable and needed to be investigated. R1 was sent to the hospital 08/16/2024 and passed away on 08/30/2024 due to UTI/sepsis at the hospital. During the visit, the LPA conducted an interview with the Administrator and assistant Administrator, conducted a brief tour of the facility and obtained copies of pertinent documents. The incident was referred to Community Care Licensing Investigations Branch (IB) and assigned to investigator Christine Ferris. The LPA determined further investigation was required prior to issuing findings.

Report will continue on LIC809-C, 2nd page.