Facility Evaluation Report

Licensing program Analyst (LPA) Alberto Lopez made an unannounced visit to investigate complaint allegations. LPA met with Co-Administrator Karen Gazon and discussed the purpose of the visit.

During the visit LPA reviewed and obtained staff and resident roster, MAR for C1 for months of February and partial month of March 2024. Reviewed medication for C1, obtained last dental appointment documentation for C1, DC order for C1, PRN authorization letters for all 5 clients (C#1-C#5) interviewed Five staff (S#1-S#5) and two residents (R#1-R#2) Notice of change in coverage for C1 medication.

During review of the medications, LPA observed three PRN medications(Pepto Bismo, Acetaminophen, and Triple antibiotic ointment) with generic label that read "HOUSE SUPPLY. USE AS DIRECTED" and nothing else. Client name, dose and label was missing from PRN as well as separate PRNs for each client.

Exit interview conducted, copy of report, 809D, and appeal rights provided.