Facility Evaluation Report

Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced case management visit to follow up on an incident report dated 12/08/2022. LPA was greeted and granted entry into the facility and explained the reason for the visit to Executive Director James Craddock.

Unusual Incident/Injury Report (LIC 624) was received on 12/08/2022 for an incident that occurred on 12/08/2022. Per LIC 624 Resident 1 (R1) advised medtech they took incorrect dosage. Medtech called 911 and paramedics came to assess R1. R1 was then transferred hospital and admitted overnight, R1 returned on 12/09/2022 without new orders.

Per interview with Staff 1 (S1) noticed that R1 did not appear well. R1 told S1 that they believe they took double dosage of self - administered medication. S1 then called 911 to have R1 assessed.

Review of LIC 602 indicates R1 cannot administer own medications but doctors orders dated 09/26/2022 state R1 can self administer 1 medication.

During the visit LPA reviewed LIC 602 and Doctors Orders dated 09/26/2022.

No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.