Facility Evaluation Report

On 05/22/23, 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 administrator Ana Kunz who explained the purpose of the visit was to gather information surrounding the death of (C1).

The regional office received a copy of the death report from the facility and reported the death of (C1) on 05/18/23. The death report stated that (CI) passed away on 05/17/23 at around 12:05 pm in Harbor UCLA Medical Center. According to the incident report (C1) was having lunch in the dining room. When (C1) completed the meal and stood up (C1) felt ill and sat back down. Care staff noticed (C1) leaning over the table and went over to check on (C1). (C1) appeared that he had a seizure. The care staff dispatched emergency medical services (EMS). Care staff started to administer CPR until (EMS) arrived and transported (C1) to the hospital. (C1) while under hospital care passed away at the hospital. The facility notified the family representative.

Physician Report for Community Care Facilities

An exit interview was conducted with Ana Kunz and a hard copy was provided.