Incident investigation·December 15, 2025

On 12/15/2025 at 2:30 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported death report. The facility sent in a death report on 12/12/2025. LPA met with Executive Director (ED), Beena Kumar, and explained the purpose of the visit. Death Report (LIC624A) indicated that Resident 1 (R1) had a change in condition and was taken to the Emergency Room per Kaiser Advice Line on 12/08/2025. On 12/10/2025, R1 passed away at the hospital. During the visit, LPA reviewed incident report, death report, R1's service plan, physician report, observation notes, and physician communication log. Observation Notes and facility incident report dated 12/04/2025 revealed that the paramedics came on 12/04/2025 to assessed R1. It also revealed that the Power of Attorney (POA) refused to send R1 to the hospital. A review of the physician communication log dated 12/04/2025 showed that the facility communicated with R1's physician due to R1's change in condition. LPA will be requesting for a death certificate from the facility. LPA may return at a later time. No deficiencies cited. Exit interview conducted and a copy of this report provided.