Facility Evaluation Report

On 8/17/2021, Licensing Program Analyst (LPA) L. Ibo conducted a Case Management visit with S1 in relation to the special incident report received on 7/28/2021, S3 mistakenly given R2's medication to R1.

R1’s physician was notified, facility staffs monitored R1's status for 24 hrs. after the incident. Facility Administrator conducted medication training with S3 on 7/29/2021. S1 requested medication replacement for R2. R1 did not show any adverse reaction from the medication that was given by S3.

LPA requested for the following documents but not limited to, Medication Administration record for R1 & R2, residents’ roster.

Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties.

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