Follow-up·January 18, 2024

On 01/18/2024 at 12:00pm Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a case management visit to follow-up on a death report received by Community Care Licensing that was faxed on 11/10/2023. LPA met with Executive Director, Adiam Welday and explained the purpose of the visit. R1 passed away on 11/02/2023 with an unknown cause of death. Administrator stated that R1 had episodes of collapsing while R1 was with the family. R1 stated that the family is the one that reported the collapsing per the Death Report. Administrator stated that no one at the facility witnessed the collapsing. During today's visit LPA obtained additional information pertaining to R1's death: Physician's Report Resident Assessment Face Sheet Assessment for Medication Self-Management Needs and Services Plan Internal Incident Report LIC809 Continued.... LIC809-C Continued... LPA requested from facility a copy of R1's death certificate. LPA was informed by Administrator that they phoned the family and left a message requesting the death certificate. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided