Complaint Investigation Report

Warning Notice (dated: 08/18/23); Facility Client Interview Questionnaires (dated: 06/08/23); Facility Internal Progress Notes (dated: 08/16/23 08/18/23); and Facility Internal Photographs of (C#1) (dated: 07/1/23,07/11/23,07/19/23 and 08/12/23).

The complaint was referred to the California Department of Social Services Investigations Branch and was assigned to Investigator (Heidy Bandana) which included a review of (C#1)’s Client #1 (C#1)’s Face Sheet; Physicians Report LIC 602 (dated: 05/30/23) Appraisal/Needs and Service Plan LIC 625 (dated: 06/08/23); Individual Service Plan (dated: 05/30/23), Refusal of Treatment Form (dated: 0/17/23) Medication Administration Record (dated: 07/01/23 – 007/31/23); Warning Notice (dated: 08/18/23); Facility Client Interview Questionnaires; Facility Internal Progress Notes (dated: 08/1623 08/18/23), and Facility Internal Photographs of (C#1) (dated: 07/1/2307/11/23,07/19/23,and 08/12/23); Los Angeles County Fire Department Emergency Medical Services (EMS) Report #2023243209000 (dated:8/25/23) Death Report LIC 624A (dated: 08/25/23); Coroner Investigator Business Card; Chest X-Ray Results; Admissions Agreement (dated: 06/08/23); ID and Emergency Information LIC 01 (dated: 06/08/223); Bay Breeze House Rules; Functional Capability Assessment LIC 9172 (dated: 06/08/23); Preplacement Appraisal Information LIC 603 (dated: 06/08/23) New Patient Registration Form; Conservatorship Court Letters; Los Angeles County Department of Medical Examiner Coroner Report Case #202-11259 (dated: 10/30/23);Long Beach Police Department Incident Report; (dated: 08/31/3); interviews with administrator #1-#2(A#1-#2); staff #1-#3 (S#1-S#3); and clients #2-#4 (C#2-#C3).

The details of the complaint reported on 08/25/23 that client #1 (C#1) was found unresponsive. (C#1) was found in (C#1)’s room at around 9:45 am, with paramedics performing cardiopulmonary resuscitation (CPR), and later was determined deceased.

On 09/12/23, (CDSS) Investigation Branch Investigator Heidy Bendana reviewed the Los Angeles County Fire Department Emergency Medical Services (EMS) 911 call and Incident Report. The date of the report listed the incident as 08/25/23 at 09:46 am. (EMS) arrived at the scene and found (C#1) with a chief complaint of full arrest. (C#1) was described as pulseless and apneic while a staff was performing (CPR) on (C#1). (C#1) had no obvious signs of trauma but was found with asystole rhythm. After 20 minutes of (CPR) with no change in rhythm, (C#1) was determined deceased. The time of death was listed at 10:12 am.