Facility Evaluation Report
Capacity44
Census28
Date signed11/04/2025 03:58:17 PM
Name of licensing program analystJacques Leffall
Name of licensing program managerSee Moua
11/4/25, Licensing Program Analyst (LPA) J. Leffall conducted a case management – deficiency visit regarding an incident report received in the Regional Office on 10/14/25. The incident occurred on 10/6/25, during which R1 was given the wrong dose of morphine. The medication error was found during a review conducted by the hospice nurse.
Citation for failing to administer medications as prescribed for R1 is on the attached 809-D.
Exit interview was conducted. A copy of this report with appeal rights were provided to A1, whose signature confirms receipt of this report.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction