Incident investigation·February 5, 2024

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Resident Service Director Cat Tomboc 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 01/31/2024 as well as self-reported incident report received at the CCLD San Diego Regional Office on 1/15/2024 and 1/31/2024. [See LIC 811 Confidential Names List for a description of R1]. Per the self-reported death document, R1 passed away on 01/30/2024. During today’s visit, LPA performed a brief facility tour and welfare check on remaining residents, finding no safety concerns. LPA also collected copies of and reviewed pertinent records and interviewed relevant staff. The Death Certificate was also requested during the visit. No deficiency was cited at the time of the visit. An exit interview was conducted with Resident Service Director Cat Tomboc, whose signature below confirms receipt of a copy of this report, the LIC811 and the Licensee Rights (LIC 9058 01/16).