Facility Evaluation Report

License Program Analyst's (LPA’s) Shannan Hansen and Victoria Bertozzi arrived at 9:00 AM to complete an unannounced annual inspection and met with Donald Stamets, Administrator. There is a total of 117 residents.

LPA's reviewed centrally stored medication record, and conducted staff interviews to complete this annual inspection.

During inspection LPA's followed up on medication error that was self reported to community care licensing on 3/16/2023. Resident had a change of dosage that was not carried out for almost 2 months after doctor changed order. Conversation with Administrator indicated facility has made changes to medication entering policies to prevent future medication errors.

LPA Hansen is requesting Licensee to update and submit the following documents by 4/22/2023 to SRRO:

LIC 308 Designation of Facility Responsibility

LIC 610 Emergency Disaster Plan (if changes)

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided..