Facility Evaluation Report

Licensing Program Analyst (LPA) Shannan Hansen arrived at 8:50 AM to complete an unannounced annual inspection and met with Terence Tumbale, Administrator. There is a total of 224 residents.

LPA reviewed centrally stored medication record, and conducted staff file review and interviews to complete this annual inspection. During staff file review it was revealed Staff (S1, S2, S3, & S4) did not have required current First Aid training/certificate (see LIC809-D).

During inspection LPA followed up on medication error that was self reported to community care licensing on 4/21/2023. Resident given double dose of medication in error as staff did not check medication records. Conversation with Administrator indicated facility has scheduled medication training for staff. (see LIC809-D)

LPA Hansen is requesting facility to update and submit the following documents by 5/13/2023 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..