Facility Evaluation Report

While at the facility investigating a complaint (Control # 15-AS-20240327144832), Licensing Program Analyst (LPA) Delmundo learned that the administrator yelled at resident (R1) which during interview, the administrator admitted to yelling when R1 becomes verbally abusive to the caregivers.

During interviews and review of records, LPA observed the following:

1. Unlocked medication in resident's (R1) room. The administrator stated R1 wants to keep the medication in the room and administer own medication, Review of LIC602A Physician's Report showed R1 can not administer own medications.

2. R1's LIC602A showed ambulatory when Pre-placement Appraisal showed non-ambulatory and R1uses wheel chair to move around and about.

3. R1's 2 medications run out; one of which with filled date 1/30/24 (quantity: 30) and the other one with filled date 2/04/24 (quantity; 30) and started administration on 2/18/24 and 2/10/24 respectively.

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 section 87465(h)(1)(C). Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalties.

Deficiencies, civil penalty and plan and proof of corrections were discussed with the administrator over the phone who authorized Belinda Dela Cruz, staff, to sign and receive this report.

Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty, LIC9098 Proof of Correction form and copy of this report provided.