Facility Evaluation Report

At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Incident visit and met with Assistant Program Manager, Ivan Arce. Administrator/Program Manager, Antyon Liggins, was available by telephone and arrived later during visit at approximately 10:45AM. The purpose of the visit was to follow up on a self-reported incident that was submitted to Community Care Licensing (CCL).

Incident Report 1: CCL received an incident report on 07/05/2023. Report states that on 07/01/2023, Care Staff was assisting Client 1 (C1) with their medications. Client 2 (C2) reached over the Care Staff's shoulder grabbing and ingesting Client 1's medication. Care staff immediately notified the Program Manager and transported C2 to the hospital to be evaluated. C2 was observed to have no side effects and returned to the facility on the same day. Since returning, C2 has been observed to be at baseline and to be doing well. Facility made all appropriate notifications per regulation.

LPA and Program Manager discussed the incident and preventative measures. LPA was informed that C2's routine involves receiving their medication first so they can get ready for bed. However with this incident, C2 was not in the medication area. Therefore, Care Staff prepared C1's medication first instead, which triggered C2 to become impatient and grab C1's medications.

LPA was informed that Facility will be conducting an In-service Training which will review the following topics: Medication Training/Proper Technique and How to Navigate Clients with Behaviors and Triggers.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC-809D, LIC 811 (Confidential Names), Plan of Corrections, and Appeal Rights, discussed and provided to Administrator. Signature on form confirms receipt of documents.