Facility Evaluation Report

At approximately 10:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 Year visit and met with Residential Supervisor, Reyna Coleman. Residential Manager, Graham Malcolm-Wium , arrived during visit at approximately 10:35AM. Facility is a Long Term Social Rehabilitation Home that provides care and assistance for Adults with Mental Health Diagnoses. Facility has an approved fire clearance and capacity for 6 Ambulatory Clients. Upon arrival, LPA was informed there were 6 clients in care and 3 staff members on-site.

At approximately 10:15AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility as required. LPA reviewed client medication. Review of centrally stored log showed that 1 of 3 client medications was not logged appropriately and had incorrect expiration and fill dates (technical violation issued, regulation 81075(j)). LPA and Residential Supervisor also reviewed incident reports that were self submitted to Community Care Licensing (CCL). Review of Incident Report 1 showed that Client 1 (C1) did not receive their medication on time (deficiency cited, regulation 81075(b)).

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, LIC809D (Deficiency Page), LIC9102 (Technical Violation/Advisory), Plan of Corrections, and Appeal Rights discussed and provided to Residential Supervisor and Residential Manager. Signature on form confirms receipt of documents.