Incident investigation·October 8, 2025

On 10/08/2025 at 12:00 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. The facility sent in an incident report on 08/31/2025 and death report on 10/06/2025 regarding Resident 1 (R1). LPA met with Health Services Director, Gigi Tamayo, and Director of Operations, Angel Lee, and explained the purpose of the visit. The Executive Director was not available during today's visit. LPA P.Manalo received a self-reported incident report from facility that indicated Resident 1 (R1) had unwitnessed fall and was admitted to the hospital for a cervical fracture. On 10/06/2025, LPA received a death report that R1 passed away. LPA reviewed and obtained R1's After Visit Summary dated 04/16/2025, Discharge Summary, Physician Report dated 02/05/2025, Resident Appraisal, Care Plans, and Physician Fax Report. LPA will be requesting full medical record, R1's progress notes dated from April 2025 to October 2025, and death certificate to be sent to CCLD. LPA may return at a later time. No deficiencies cited during visit. Exit interview was conducted with Tamayo and Lee and a copy of this report was provided.