Facility Evaluation Report

On 10/02/23, Licensing Program Analyst, LPA Ernand Dabuet conducted a Case Management visit to follow up on the death reported for Client #1 (C1). LPA was greeted by Program Manager Nickie Southall. LPA explained the purpose of the visit was to gather information surrounding the death of (C1).

LPA Dabuet received an email from Southall on 09/27/24 who reported the death of (C1) on 09/27/24 and later submitted an incident report LIC 624. The death report stated that (CI) passed away on 09/27/24 at 8:00 am at Harbor UCLA Medical Center (HUCLAMC). According to the incident report (C1) was admitted on 09/25/24 was recommended by Harbor Regional Center physician as (C1) was unable to urinate within the 24-hour period. Emergency Medical Services were dispatched on 09/25/24, (C1) while being observed at the hospital was taken off prescribed meds and was administered morphine and was placed on comfort care while at the hospital. (C1) while under hospital care when (C1) passed away.

ID and Emergency Information (dated: 04/21/23)

Physician Report for Community Care Facilities LIC 602A (dated: 03/16/23)

Quarterly Nursing Assessment (dated: 09/25/24)

Medications (MAR) (dated: 09/01/24 - 09/26/24)

Incident Report LIC 624 (dated: 08/08/24)

Progress Notes (dated: 09/09/24 - 09/27/24)

Vital Signs Record (dated: 09/07/24 - 09/25/24)

Hydration Chart (dated: 09/01/24 - 09/26/24)

Body/Skin Check Form (date: 09/03/24-09/24/24)

A brief interview was conducted with Nickie Southall regarding (C1's) health condition,and a hard copy of the report is provided.