Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a Case Management Visit-Incident on 03/13/2025, stemming from Special Incident Report received on 12/19/2024. LPA was greeted by Administrator Samuel Cabaron and explained the purpose of the visit.

According to incident report dated 12/19/2024, staff#1 (S1), reported to Administrator Cabaron on 12/17/24 at 7pm, that client#1 (C1) was not administered three of their 4pm medications. C1’s primary care physician (PCP) was notified and advised staff to closely monitor C1 till the following morning for any possible side effects. Staff later reported C1 did not have any adverse reactions. Facility registered nurse (RN) would provide re-training to staff before resuming medications passing.

On 3/13/2025, LPA Ramirez toured facility and reviewed training records for staff. LPA Ramirez observed medications re-training for staff was conducted on 12/20/2024 .

Based on records reviewed and interviews conducted, one (1) type A deficiency is being cited for violation of Title 22, Division 6, Chapter 1, Article 06. Continuing Requirements- 80065 Personnel Requirements- (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.

Exit interview was conducted and a copy of this report, 809-D and appeals rights was provided via email.