Facility Evaluation Report

On 12/9/21 at 12:30 PM, Licensing Program Analysts (LPAs) Malia Thao and Mary Garza arrived unannounced to conduct a case management - incident inspection. LPAs explained reason for inspection and was granted entry. LPAs met with Administrator Diedra Grigsby and Assistant Manager Jason Martinez.

Facility submitted two incident reports to CCL on 11/3/21. One incident involved R1 being left at the store while grocery shopping with staff. Second incident reported R2 was given a double dose of medication. LPAs reviewed records and conducted interviews.

1. R1 walked away from group during a grocery outing. R1's physician report states R1 can not leave the facility unassisted.

2. R2 was given a double dose of medication Bethanechol 10 mg at 8am. S3 administered both doses of medication for 8am and 2pm at the 8am medication administration.

Deficiencies are being cited based on LPAs' interviews and records review in accordance with the California Code of Regulations, Title 22, see LIC809D.

An exit interview was conducted and Plans of Corrections were reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and emailed to Administrator Diedra Grigsby with "Read Receipt" to confirm receipt of this report.