Facility Evaluation Report

On 11/26/2024, Licensing Program Analyst, LPA Zina Brown conducted a Case Management visit to follow up on the death reported for Client #1 (C1). LPA was greeted by facility coordinator Kristine Angeles and and assistant administrator Anna Marie Peji. LPA 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 who reported the death of (C1) on 11/25/2024. The death report stated that (C1) passed away on at Long Beach Memorial Hospital(LBMH) According to the incident report (C1) was admitted on 11/23/2024 for general weakness. Emergency Medical Services were dispatched on 11/23/2024, (C1) was not feeling well. A staff was notified by 911 in regards to (C1) due C1 have a history of calling 911 unfalse pretenses. (EMS) arrived to the facility to transport (C1) to the hospital immediately.

(C1) while under hospital care passed away at the hospital. The facility was notified of (C1's) passing by (C1's) public guardian.

ID and Emergency Information (dated: 05/23/2023)

Physician Report for Community Care Facilities LIC 602A (dated: 10/05/2024)

Preplacement Appraisal Information LIC 603 (dated: 05/23/2023)

Incident Report LIC 624 (dated: 4/23/23 - 4/01/24)

An exit interview was conducted with Kristine Angeles(Facility Coordinator) and a hard copy was provided.