Incident investigation·April 12, 2023

On April 12, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on a death report submitted on April 6, 2023. LPA met with Business Office Manager, Winnie Sato and Resident Service Director (RSD) Rowena Cancino and explained the purpose of the visit. The Licensee reported on March 21, 2023, Resident 1 (R1) passed away and that the immediate cause od death was not disclosed. Based on the death report that was submitted to CCL, the private caregiver notified the Resident Services Director that R1 was choking from his/her phlegm and when the Resident Services Director arrived to R1's room, R1 was not responding. During the visit today, LPA reviewed R1's file and requested copies of documents. Based on file reviewed, R1 is an Assisted Living resident who has no prior history of choking or swallowing. LPA to follow up on this incident after reviewing documents collected and facility to request a copy of death certificate. In addition, during the visit today, LPA found that the facility failed to report as required. According to CCR 87211 Reporting Requirements, the licensee shall send a written report to the licensing agency and the person responsible for the resident when a resident dies, regardless of cause or where death occurred, within seven days of the death. It was observed in R1's death report that R1 passed away on March 21, 2023, however the death report was not submitted to CCL till April 6, 2023. Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC 809D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with Resident Service Director and a copy is provided with appeal right