Incident investigation·November 20, 2024

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Cristina Mascarinas. LPA also spoke with Administrator Lailani Velasco via phone during the visit. Today's visit was in response to licensee’s self-reported death of Client #1 (C1), received at the CCLD San Diego Regional Office on 11/20/2024. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report]. Per the report, C1 passed away on 11/19/2024. During today’s visit, LPA performed a brief facility tour and welfare check on remaining clients, finding no safety concerns. LPA also collected copies of and reviewed pertinent records and interviewed relevant staff. Per review of CCLD’s Guardian Database and corroborated by staff and manager interviews: Staff #1 (S1), who was present at the facility during today’s visit, possessed an active background clearance from CCLD (to work in care facilities). However, Licensee did not ensure that S1 was associated to the facility’s roster of staff, as was required. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the LIC809-D page). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Administrator Lailani Velasco, to whom a copy of this report, the LIC809-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.