Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Case Management Visit to follow up on a Death Report received on 3/28/2024. LPA met with Faviola Padilla, Med Tech for the facility, and explained the purpose of the visit.

Per Special Incident Report (SIR) received, Client #1 (C1) was pronounced deceased at Beverly Hospital in Montebello.

During today's visit LPA interviewed the administrator, who explained that C1 came to the medication room on 3/27/2024 because they felt something rip inside their stomach and asked staff to call 911. During the hospital stay, the hospital staff attempted to perform surgery on C1 and reported to the facility that C1 had suffered a ruptured large intestine, which may have been caused due to C1's prolonged constipation. On 3/27/2024, hospital staff informed the facility that C1 had passed away following the surgery.

During the visit, LPA obtained copies of C1's Appraisal Needs and Services Plan, Physician's Report, Identification and Emergency Contact Sheet, and Medication Administration records for the previous 3 months from the assistant administrator Christina Vasquez. Assistant Administrator Christina explained that he will obtain the death certificate for C1 and provide it to the LPA as soon as it becomes available.

LPA also toured C1's bedroom. No concerns, obstructions, or anything out of the ordinary were witnessed during the visit.

No deficiencies observed during today's visit. Exit interview help and a copy of the report was provided to the facility.