Incident investigation·September 17, 2025

On September 17, 2025, at 8:45 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced Case Management Visit to follow-up on a death report received from the facility. LPA Kim was greeted by Executive Director (ED) Austin Morris and LPA Kim explained the purpose of the visit. ED Morris could not stay for the visit and stated Resident Service Director Mirian Im could sign on behalf of the facility. During today’s visit, LPA conducted a health and safety check, and there were no imminent health/safety concerns observed. Facility is maintained at a comfortable temperature for the residents in care. LPA obtained Staff Roster, Resident Roster, and R1’s records which includes the Physician’s Report, Emergency Information, Appraisal and Needs/Service Plan, and other pertinent documents. LPA interviewed two staff and one witness. Based on record review, the Incident report received by the Orange County Regional Office on September 12, 2025, R1 was sent to the hospital on September 10, 2025, due to shortness of breath and noticeable confusion during a Home Health Nurse visit. On an incident report dated September 16, 2025, dated on September 13, 2025, around 2:00 AM, R1 passed away. The incident report dated September 16, 2025, and the hospital discharge summary dated September 12, 2025, both stated R1 returned to the facility on September 12, 2025, diagnosed with Chronic Obstructive pulmonary disease (COPD). The hospital discharge report on page 6 stated COPD is a lung disease, where the lungs get damaged making it hard to get air in and out of the lungs. The damage cannot be changed. R1’s physicians report dated July 15, 2025, diagnosed R1 with COPD. There is no coroner’s report but a card with the coroner case number and death report number was provided to the facility. Evaluation Report Continues on LIC 809-C Based on interviews conducted, one witness and two staff denied this to be a questionable death. W1 stated R1 passed away due to natural causes. There is no foul play suspected from the facility. S2 stated on September 10, 2025, a home health nurse noticed that R1 had a collapsed lung. From the recommendation of the nurse, the facility sent R1 to the hospital to be treated. Based on record review and interviews conducted, this incident is not a questionable death. No deficiencies were observed during this visit. An exit interview was conducted, and a copy of this report was provided to the Resident Service Director Mirian Im.