Incident investigation·April 6, 2026

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 Executive Director Abraham Botello. Today's visit was in response to an LIC624 Incident Report and an LIC624A Death Report regarding Resident #1 (R1), which Licensee self-submitted to the CCLD San Diego Regional Office (RO); both reports were received on 04/03/2026. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report]. According to these reports: R1 fell at the facility on 03/25/2026, for which they were hospitalized. Then on 03/26/2026, R1 died at the hospital. During today’s visit, LPA performed a brief facility tour and welfare check on remaining clients, finding no immediate safety concerns. LPA collected and/or requested copies of and reviewed pertinent records and interviewed relevant staff. LPA also provided Technical Assistance (TA) / education to Botello regarding CCLD’s Provider Information Notice (PIN) 26-06-ASC, titled, “Calling 9-1-1 in Residential Care Facilities for the Elderly (RCFE).” A physical copy of the PIN was provided to Botello, and an electronic copy of the same was E-mailed to both him and the facility’s Resident Services Director, Richard Tibi. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] The above LIC624 and LIC624A reports were both received at the RO late, meaning not within seven (7) days of either R1’s fall or R1’s subsequent death, respectively, as required by regulation. One (1) deficiency was cited today per California Code of Regulations, Title 22 (refer to the attached LIC809-D page). Since this deficiency was a repeat violation within a twelve (1 2) month period, a Repeat Violation Civil Penalty of $250 was assessed/charged (refer to the LIC421-FC page). An exit interview was conducted with Executive Director Abraham Botello, to whom a copy of this report, the LIC809-D page, the LIC421-FC page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.