Facility Evaluation Report, 06/12/2024 — Key West Guest Home, INC., Temple City CA

Licensing Program Analyst (LPA) Sanjay Vaid initiated a case management visit to follow-up on the death of Client #1(C1). At 1125AM Concepcion Pacania was present at the facility, contracted administrator via phone. Administrator Marilyn Acabal had previous appointment and could not conduct case management visit. Concepcion Pacania will sign on Administrator Acabal’s behalf.

Facility completed death report for C1 dated 05/30/2024. C1 passed away at Arcadia Methodist Hospital on 05/30/2024. According to the report, on 05/15/24 the client’s physician prescribed medication to be taken daily every 8 hours for 5 days as needed for phlegm and intermittent cough. On 05/22/24 staff informed the physician that the client had continuous and productive cough and phlegm. On 05/26/24 at 5:40 pm C1 was not able to spit out the phlegm accumulated in C1’s throat and was observed by staff having a hard time clearing the phlegm in the throat and chest. Staff called paramedics and transported C1 to San Gabriel Valley Medical Center, physician on duty ordered chest Xray, urine and blood work for influenza A and B and Covid antigen tests. On 05/28/24 C1 was seen by a personal physician who ordered Nebulizer, Albuterol to be administered by Home Health. At 6:40 pm after C1 returned to the facility, the Administrator observed C1 congestion not improving with abnormal breathing patterns, staff call 911 and was taken to Arcadia Methodist Hospital and admitted for further treatment. C1 was intubated on the night of 05/28/24, on 05/29/24 C1’s mother and sister signed an advanced directive and intubation was removed. On 05/30/24 at 1am C1 passed away according to family members. The official cause to death is Respiratory Failure, Pneumonia.

LPA reviewed the facility file for client #1 were received and reviewed on 06/11/2024; Needs & Service Plan, physicians report and IPP. LPA requested copies of the following documents be mailed to licensing: Death Certificate. Administrator is working with C1's family to obtain the Death Certificate.