Facility Evaluation Report

On 4/29/2026 at 10:30 AM, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 4/24/2026. LPA met with Angela Turin, Executive Director and explained the purpose of the visit.

S1 submitted an incident report that stated that R1 ingested a small amount of Mckesson Perineal & Skin Cleanser fluid. The incident report states that the incident happened on 4/20/2026 at around 10:51 pm. S1 stated that S2 was conducting a routine visit in R1's room when they observed R1 removing the cleanser down her mouth and S2 observed R1 having a facial expression that appeared to be a "bad taste." S1 stated S3 called Poison Control around 10:55 pm and poison control told S3 to give R1 water and to monitor R1. S1 stated that R1 was monitored throughout the night by S3 and the hospice nurse and resident remained at baseline. S1 stated that R1 was also monitored the following day and stayed at baseline. S1 stated that they contacted the responsible parties. S1 stated that staff removed all of the hazardous items from R1's room and notified hospice. R1 was not resulted in any ill side effects due to this incident. LPA interviewed Staff (S1). LPA was unable to interview R1 at this time since R1 was sleeping during the visit. LPA obtained and reviewed the following documents: R1's appraisal needs and services plan, LIC602 (Physicians report), and MAR (Medication Administration Record)-March & April. LPA also reviewed R1's hospice care plan.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted with Angela. A copy of the appeal rights and this report was provided.