Facility Evaluation Report

Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent case management visit to deliver findings for the death investigation initiated on 02/27/2024 case management visit. LPA met with Administrator Cilva Toume and Assistant Administrator Vana Barberis and explained the reason for the visit.

On 02/26/2024, the Department received a self-reported death report from the facility. The death report stated that on 02/20/2024, Resident #1 (R1) was seen choking on their saliva by the caregiver on duty. The caregiver immediately called 911 and began CPR. The Department referred the case to the Community Care Licensing (CCL) Investigations Branch (IB). The case was assigned to Investigator Laura Garcia to conduct the investigation.

On 02/27/2024, from 3:15pm to 6:45pm, Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management – Incident visit to the above facility. LPA Cortez met with the administrator Cilva Toume and explained the reason for the visit was to follow up on the self-reported death report received on 02/26/2024. The report pertained to the 02/20/2024 death of Resident #1 (R1). During the visit, the LPA conducted interviews with staff and R1's resident representative, conducted a brief tour of the facility, and obtained copies of pertinent documents. The LPA informed the administrator that the incident was referred to the Community Care Licensing (CCL) Investigations Branch (IB) for review and further investigation was required prior to issuing findings.

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