Incident investigation·January 26, 2026

On 01/26/2026 at 9:25 AM, 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 01/08/2026. LPA met with Co-Administrator, Warlita Rivac, and explained the purpose of the visit. Death Report (LIC624A) indicated that on 01/07/2026 Resident 1 (R1) passed away on 01/07/2026. Report indicated that R1 was alert and responsive, and the immediate cause of death was respiratory problem. During the visit, LPA reviewed and obtained documents including but not limited to Admission Agreement, After Visit Summary, Incident Report, Facility’s Communication Log, Physician Report, Physician Orders for Life-Sustaining Treatment (POLST), and Identification and Emergency Information. LPA interviewed Co-Administrator and Staff 1 (S1). LPA will be requesting for a death certificate. LPA may return at a later time. No deficiency cited during today’s visit. Exit interview conducted and a copy of this report provided.