Facility Evaluation Report
On 05/07/2025 at 9:00 AM, Licensing Program Analyst (LPA) P. Manalo conducted an unannounced case management visit regarding an incident report that was reported to CCLD on 04/30/2025. LPA met with Direct Care Staff, Fidel Decastro, and explained the purpose of the visit. Fidel phoned, Administrator, Tsion Haile to inform. The Administrator was not available to come to the facility, but gave authorization for Fidel to sign the report.
On 04/30/2025, LPA P.Manalo received an Incident Report regarding missed medication for Client 1 (C1). The Incident Report indicated that C1 missed a dose of their medication on 04/29/2025 at 2PM. Based on interview with the Administrator, C1's medication was changed recently and that new medication order was communicated to staff on 04/27/2025. However, Staff 1 (S1) had missed giving C1 the medication dosage for 2PM on 04/29/2025.
During the visit, LPA reviewed the Medication Administrator Record (MAR) and the new doctor's order for the medication change.
The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiency by POC date may result in additional Civil Penalties.
Exit interview conducted with Staff. Appeal Rights and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction