Facility Evaluation Report

On 12/7/2023 at 2:05pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 12/4/2023. LPA met with Reymund Tulabot, Caregiver. Administrator arrived at 2;35pm and LPA explained the purpose of the visit.

S1 called and spoke with LPA on 12/4/2023 regarding the incident and followed up with an incident report the same day. During telephone conversation with S1 it was stated that S4 was a volunteer at the facility and gave the wrong plate containing crushed medication in pureed food to R1. LPA checked guardian in the regional office and observed that S4 was not associated to the facility. Upon arrival S3 answered the door. LPA checked guardian and observed S3 was not associated to the facility. During visit LPA called the regional office to verify if both S3 and S4 were fingerprinted and it was confirmed they were not. LPA reviewed R1 and R2's file and both physician's reports did not indicate any special diet and only one showed meat should be cut. There was not any other documentation for food preparation.

LPA obtained the following for R1 and R2 during visit: admission agreement; physician's report, appraisal needs and services plan, facility roster, and staff roster.