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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601257
Report Date: 02/07/2025
Date Signed: 02/07/2025 02:33:22 PM

Document Has Been Signed on 02/07/2025 02:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CLIMB, INC. - ARF 5FACILITY NUMBER:
198601257
ADMINISTRATOR/
DIRECTOR:		SYULLI RUMAGITFACILITY TYPE:
735
ADDRESS:3626 BROOKLINE AVE.TELEPHONE:
(626) 289-5321
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 6CENSUS: 3DATE:
02/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:23 PM
MET WITH:Terry Del Mundo, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Alberto Lopez conducted a Case Management (CM) unannounced visit to obtain additional information involving the death of Client #1 (C1). LPA met with Administrator Terry Del Mundo and discussed the purpose of today's visit.

LPA took a tour of facility including bedrooms. LPA interviewed Ms. Del Mundo pertaining to C1's death. The date of death was 01/26/2025. C1 was admitted to Hospice on 01/25/2025. Per Administrator, she will request copy of death certificate.

On 01/26/2025 at 4:45am, Staff Leon Prentis, night shift staff notice C1 was pale and not breathing or responding to staff. Staff called 911 right away and then the Administrator.
Administrator Terry Del Mundo called A Plus Hospice and reported the death. Paramedics performed CPR but not able to resuscitate C1.

LPA reviewed and obtained copies of various documents of C1 file. LPA requested Ms. Del Mundo to attempt to obtain a copy of the death certificate and Sheriffs' report (if report is available). If/when Ms. Del Mundo can obtain the death certificate report and sheriff report she will fax a copy to Licensing.

LPA did not observed any health or safety risks during visit. It has been determined that the there was no foul play or neglect involved in the death of C1. Administrator stated C1 had DNR order. (will fax DNR order to LPA)

Exit interview conducted and a copy of this report was provided to Terry Del Mundo (Facility Administrator)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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