Facility Evaluation Report
On November 6, 2024, Emelita Dimaguila, administrator (ADM), sent a correspondence to Licensing Program Analyst (LPA) Delmundo. Correspondence indicated that resident (R1) who was admitted to the facility on October 25, 2024 and have prescribed medications of which 4 are available over the counter (OTC) were not received. The 4 medications were purchased on November 5, 2024. R1 missed the 4 medications from October 25, 2024 to November 5, 2024.
On this day, November 15, 2024, LPA Delmundo arrived unannounced to conduct a case management in response to the above incident. LPA reviewed R1's file and documents LPA received.
Written Special Incident Report (SIR) was submitted on November 8, 2024. Review of R1's records revealed the follo wing:
1. LIC602A Physician's Report h as no doctor's signature.
2. No LIC601 Identification and Emergency Contact Information
3. Facility received R1's P&I according to ADM and facility has not submitted an updated LIC400 Affidavit Regarding Client/Resident Cash Resources nor have obtained Surety Bond coverage.
Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $250.00 civil penalty is assessed for repeat violation of deficiency section 87465(a) . Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalties.
Deficiencies, plan and proof of corrections, and civil penalty were discussed with the ADM.
Exit interview conducted. Appeal Rights, LIC421FC, LIC9098 Proof of Correction form and copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction