Senior Care Records.

Facility Evaluation Report

Ithaca Home, Hayward01/11/2024Licence 015600545

Capacity6
Census4
Date signed01/11/2024 03:56:15 PM
The inspector’s account

On 01/11/2024 at 11:10AM Licensing Program Analysts (LPAs) L. Alexander and L. Fontanilla arrived unannounced to conduct a Case Management visit. LPAs met with Caregiver, Florante "Dan" Landingin. Dan phoned Licensee/Administrator, Victor De Leon to inform. Victor arrived approximately at 11:15AM

While LPAs L. Alexander and L. Fontanilla were conducting a complaint investigation (15-AS-20240102142901) on 01/11/2024. LPAs observed the following:

At 10:53AM, medication unlocked located in refrigerator outside

At 10:54AM, scissors unlocked on counter located in kitchen

At 10:55AM, Colchicine 500 MCG Tablets unlocked laying on dining room tablet

At 11:00AM, unlocked Sulfamethoxazole E-Tm Sup prescription medication, over the-counter Acetaminophen and Gummies vitamins located in client's bedroom#3.

The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction