Incident investigation·June 23, 2023

On this day at around 11:50 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct case management visit in connection with a suicide incident that occurred at the facility. LPA met with Resident Care Director (RCD) David Ayala and explained the purpose of visit. LPA obtained the following records for Resident 1 (R1): 1. Physician's Report 2. Preplacement Appraisal 3. Admission's Agreement 4. Psychiatric Evaluation 5. Service Plan 6. Emergency Information 7. Letter A referral to Investigations Branch (IB) has been made. LPA advised RCD to send all incident/death reports to CCL via fax at 510-286-4204 or email to CCLASCPOaklandRO@dss.ca.gov and not to send to any LPA email address. A copy of this report was provided to RCD.