Incident investigation·August 16, 2023

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management in response to the Unusual Incident Report (UIR) for resident (R1) submitted by the facility to the Department on June 27, 2023. LPA met with Lulin 'Lucy' Wu, administrator, and licensees, Wendy Wong and Olive Manalastas, and informed the reason for visit UIR indicated that on June 26, 2023 at 8:30 am. staff was going to help resident (R1) with morning grooming and noticed R1 unresponsive. Staff immediately called 9-1-1, and started CPR. At 8:45 am, the paramedics pronounced time of death. Police Officer arrived at the facility, took report. and called Coroner's Office. Coroner grant the release of R1's body. R1's son and daughter came to the facility, and called the mortuary. On this day, August 16. 2023, LPA reviewed R1's records including but not limited to LIC602A Physician's Report, doctor's order of medications and Medication Administration Record. LPA obtained copies of documents and conducted interviews. No deficiency cited during today's visit. Exit interview conducted, and copy of this report provided.