Incident investigation·January 10, 2024

Licensing Program Analysts (LPA) Dang Nguyen and Juliana Barfield conducted an unannounced Case Management - Incident visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Jolin Ly. LPAs also met and spoke with Administrator Dominique Mase, who arrived later during the visit. Today's visit was in response to licensee’s self-reported death of Resident #1 (R1), received at the CCLD San Diego Regional Office on 01/09/2024. [See LIC 811 Confidential Names List for a description of C1]. Per the report, R1 passed away on 01/05/2024. During today’s visit, LPAs 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. No deficiencies were cited during today’s visit. However, one (1) Technical Violation was issued regarding Maintenance and Operation (see the LIC9102-TV). An exit interview was conducted with Ly. A copy of this report, the LIC9102-TV, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to the Licensee during the visit.