Facility Evaluation Report

Licensing Program Analyst (LPA) Sandra Urena conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20251011205324). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation unrelated to the complaint. During today’s visit, LPA met with the Administrator and explained the reason for the visit.

During the course of the investigation, it was discovered that Resident #1(R1) was given unprescribed medication on 10/10/2025. The LPA conducted facility data system review, and it revealed that the Licensee/Administrator did not submit an Unusual Incident Report (LIC 624). The unprescribed medication administered to the residents was not reported or communicated with the Department. Furthermore, in the course of the investigation, the LPA discovered Staff’s (S1) record review revealed that S1 did not have medication training on file.

Pursuant to Title 22, California Code of Regulations and CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.