Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on incident report submitted to Community Care Licensing on 11/17/2021. LPA was greeted and granted entry into the facility by Caregiver Dominga Santillian and explained the reason for the visit. Administrator/ Licensee Jay Pichika arrived during the visit.

Incident report dated 11/17/2021 indicated Resident 1 (R1) was taken to the urgent care due to possible UTI and Depakote overdose. Administrator stepped out of urgent care for a zoom meeting. Urgent care determined R1 needed to be seen at the emergency room and was unsuccessful in reaching the administrator. Per witnesses, urgent care reached out to facility staff as well as responsible party to advise of the situation. Administrator states being unable to answer phone due to the administrator's zoom call. Administrator made contact after the zoom call and R1 was sent to the emergency room. R1 was diagnosed with a urinary tract infection. R1's levels of Depakote were deemed to be acceptable and facility continues to follow the medication orders on file as responsible party is in contact with physician to change the order to a lower dose. Witnesses interviewed indicate R1 is currently incontinent and incontinence care is not being provided at night.

Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.