Incident investigation·October 26, 2023

On 10/26/2023 at 2:25PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit to follow-up on a death report received by Community Care licensing. LPA met with Joseph Villanueva (ED) and Deborah Bradley, Assistant Executive Director (AED) and explained the purpose of the visit. Executive Director had to continue a staff meeting. However, the Assistant Executive Director met with LPA to discuss the incident. R1 passed away on 10/12/2023 with an unknown cause of death. During today's visit LPA obtained additional information pertaining to R1's death: Death Report Physician's Report Dated 06/24/19 Needs and Services Plan Level of Care Notification/Care Plan 08/22/23 Care Plan Prescribed Medication Residence and Care Agreement Chart Notes LPA requested from facility a copy of R1's death certificate and also a copy of the police report. LIC 809 Continued.... LPA was informed by Assistant Executive Director that family will provide R1's death certificate, once available and will provide CCL a copy. No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided.