Incident investigation·March 5, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced to follow-up on the death report and incident report. LPA met with Executive Director (ED) Justine Ortiz and explained the purpose of the visit. During the course of the visit, LPA interviewed two staff and reviewed pertinent documentation such as the Death & Incident Reports dated February 19, 2025 and Progress Notes dated February 19 - February 27, 2025. The incident is as follows: On February 25, 2025 at 3:11pm, the Department received the Incident Report (LIC624) and Death Report (LIC624A) for Resident #1 (R1). It was reported that R1 was discovered unresponsive in their room with food in their mouth by staff on February 25, 2025 at 9:37am. Per review of the Physician's Report dated January 1, 2025, R1 does have a special diet but is able to feed self. Staff performed CPR while on the 911 call. Fountain Valley Police Department and paramedics arrived to assist and transported resident to the hospital for further evaluation after detecting a pulse. R1 passed away at the hospital. There were no health and safety violations noted during today's visit. An exit interview was conducted with Executive Director Justine Ortiz, and a copy of this report was emailed during the visit.