Incident investigation·September 25, 2024

On 9/25/24 at 1:55pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to conduct a case management visit related to recently submitted death report. LPA met with the Designated Staff, Shadae James (S1) and explained the purpose of the visit. Present during today's visit were 3 residents in care with 2 staff (S1 and S2). LPA reviewed death reports for Resident (R1) and accompanying documentation with S1 and confirmed accuracy of the report. At this time, the facility has not receive a death certificate. After reviewing the death report with S1, S1 needed to leave the facility for a resident appointment. S2 was the only staff on duty for the rest of the visit. Death report stated that R1 had passed away as a result of aspiration while eating dinner. Per record review and interview with S1, incident occurred on 9/10/24. The death report was received by the Department on 9/19/24, which is outside the reporting requirement. The following deficiencies were observed and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. The deficiencies can be found on the 809-D page. During the exit was interview, LPA reviewed the report and Plan of Correction with S1 over the phone and S2 signed this report, and a copy of this report and appeal rights were provided to the facility.