Incident investigation·May 30, 2025

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to follow up on an incident reported to Community Care Licensing. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Executive Director Ernest "EJ" Lewis. Community Care Licensing received an Incident Report on 5/22/25 in which it was reported that Resident #1 (R1) was found unresponsive by care staff during morning rounds. Emergency services were called and R1 was pronounced deceased. Due to unknown cause of death, LPA conducted follow-up. During today's visit, LPA conducted file review and provided consultation with Executive Director Lewis. No Deficiencies were cited during the visit. An exit interview was conducted with Executive Director Lewis to whom a copy of this report was provided. Their signature below confirms receipt of this document.