Facility Evaluation Report

On 11/19/2025 at 2:30pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding incidents that were reported to CCLD. Two (2) incidents on 11/11/2025 and one (1) on 11/15/2025. LPA met with Nicolas Dedicatoria, Administrator and explained the purpose of the visit.

The incidents reported occurred on 11/10/2025 and 11/11/2025. The reports stated on 11/10/2025 and 11/11/2025, S1 was notified by text from lead staff that the count for the medication was off. S1 investigated medication count and observed the PM does was missed. S1 also observed the passer and verifier both signed there initials on the medication administration record (MAR).

The incident reported on 11/15/2025, stated S1 was notified by staff that the AM dose on 11/14/2025, was not given to client by the lead staff. After S1 reviewed the situation, it was found that the medication cups were returned to the medication drawer and the lead staff signed the MAR.

*An immediate $250.00 civil penalty will be assessed on today's date for a repeat deficiency*