Facility Evaluation Report

An unannounced Case Management Incident visit was conducted on this day by Licensing Program Analyst (LPA) Rosaura Valenzuela. The purpose of this visit is to follow-up on an incident report that was submitted to Licensing on 4/04/24 regarding Resident #1 (R1). LPA met with LVN Mary Lou Dominguez and explained the reason for the visit.

It was reported that on 3/31/2019 at approximately 3:21 pm staff received a call from R1's spouse indicating that R1 had overdosed on prescribed medication. 911 was called and R1 was transported to the hospital.

On 4/08/2014, LPA Valenzuela spoke to LVN Mary Lou Dominguez. Interview revealed that R1 is still at the hospital. Facility is awaiting the discharge orders and to conduct a reappraisal before accepting R1 back to the community.

LPA requested and reviewed the following documents: R1's physician report, medication list, pre-appraisal, and medication orders from the physician. Records revealed that R1 is depressed. R1 does have approval from their doctor to self-administer their own medication. Facility contacted the hospital and asked what the laboratory results were. Hospital staff indicated that blood work was unremarkable. Apparently R1 did not ingest the medication that was reported to have been taken.

Exit interview conducted and a copy of the report was issued.