Facility Evaluation Report

Licensing Program Analyst (LPA) Hansen arrived unannounced at facility to continue a complaint investigation. During today's investigation, while reviewing medication records with Program Director Anna-Lena Karlsson, it was revealed 3 clients (C1,C2, &C3) were not given some of their medications on 10/16/2023. C1 & C3 missed their noon medication and C2 missed one of their morning medications. No adverse side effects noticed. Program Director did not know why this was missed.

Facility uses KIPU electronic Medication Record Keeping system that indicates if a client took their medication or not & why, as well as what time, and which staff documented it. System also shows clients signature indicating knowledge of. LPA reviewed the facility's "Medication Protocol" with Program Director. Additional safeguards and precautions will be put in place. Staff will attended refresher training on medication procedures with facility Nurse.

LPA is citing the facility for failure to assist a client with self-administration of prescription medications.

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..