Facility Evaluation Report

On 4/20/2023 at 1:35 PM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct a case management visit. CCL received a Special incident report (SIR) on 4/16/2023, regarding C1 took wrong medications.

Administrator self reported the incident to CCL. Staff (S4) left medicine cup with F1’s medication on the dining room table. C1 grabbed the medications and took it. During the course of interview and records review, C1 ingested at least seven psychotropic medications.

Administrator took C1 to emergency room (ER) on the same day. Poison control was contacted while C1 was at the ER. C1 stayed at the hospital for couple of hours for observation. Based on records review, C1 had tachycardia as side effects of the medications but no other side effects.

During the visit, LPA attempted to interview C1, however C1 was non-verbal and could not answer LPA questions. LPA observed that C1, appeared to be comfortable at the facility.

Administrator contacted their contract pharmacy to conduct staff medication training. A medication training was conducted on 4/17/2023.

The above deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.