Facility Evaluation Report

In conjunction with the complaint investigation, (complaint number # 31-AS-20250404163531), Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted a case management visit to address the deficiencies unrelated to the complaint.

During the complaint investigation, completed by Senior Investigator (SI) Heidy Bandana it was found that on 2.24.2025, R1 primary care physician (PCP) discontinued the prescription for Hydrocodone- Acetaminophen (Norco) tablet, 5-325 mg, two tablets every six hours as needed. According to R1’s PCP, they wrote a new prescription for Hydrocodone-Acetaminophen (Norco) tablet, 10-325, one tablet every four hours as needed. Per centrally stored medication and destruction records (CSMDR), reviewed by SI-Bendana, the facility was giving R1 two tablets of Hydrocodone-Acetaminophen instead of one as prescribed as of 02.24.25. In addition, Incident report dated 3.21.2025, started at 1100 hours, R1 took his prescribed Hydrocodone 10-325 mg; then the incident report also stated R1's last dose was administered at 1000 hours. The day of the incident, R1 was found sweaty, warm to the touch, unresponsive, drooling, with snoring respiration. R1 became somewhat alert after paramedics administered two Narcan injections.

Based on the interviews, and record review, the facility failed to provide proper medication assistance to R1, which reflected R1’s health and safety. A deficiency is cited on the corresponding LIC 809-D page.

Deficiencies Cited. Exit Interview Conducted. Report Issued.

Licensee was informed that an immediate Civil Penalty of $500.00 will be issued to the facility at the time of this visit. Additional civil penalty maybe be assessed at later time based on Health and Safety Code 1569.49.

Exit interview was conducted. Appeal rights discussed and a copy of report was issued.