Facility Evaluation Report

On 05/26/2026 at 10:15 AM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported missed medication that occurred on 05/13/2026 that was reported on 05/14/2026. LPA met with Executive Assistant, Victoria Young, and explained the purpose of the visit. Jon Mccraw gave verbal authorization on the phone for Young to sign the report.

LPA received an incident report that Resident 1 (R1), R2, and R3 did not receive their morning insulin on 05/13/2026. Interview with S1 indicated that the facility nurse was not available during the morning medication pass and all 3 residents' insulin dosage was missed.

LPA reviewed and obtained the following documents including but not limited to Incident Report dated 05/14/2026, Progress Notes, Medication Administration Record (MAR), physician's order, M.D Communication/ Advice Form, and physician report (LIC602A). A review of R1, R2, and R3's signed physician's order indicated that R1, R2, and R3 are scheduled to have their first dosage of insulin at 8:00 A.M. Interviews with staff members and M.D Communication/ Advice form indicated that the facility contacted the appropriate parties such as the physician for R1, R2, and R3 on 05/14/2026.

The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalties.

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