Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on incident reports received by the department. LPA was greeted and granted entry into the facility and explained the reason for the visit.

Incident report dated 06/09/2026 indicated Resident 1 (R1) did not receive prescribed medications Trazadone, Donezepil, and Escitalopram due to Staff 1 (S1) forgetting to administer the medications. No after effects noted. Per physician report dated 09/07/2025, R1 is diagnosed with Dementia and is on med management at the facility. S1 was written up and provided re-training.

Incident report dated 06/12/2026 indicated R2 was administered a nasal spray inhalation medication that was prescribed to the resident's spouse. Staff 2 (S2) administered the medication as the spouse told the staff to administer. There were no after effects. Per physician report dated 12/01/2025, R2's primary diagnosis is Hypertension. S2 was terminated.

Incident report dated 06/23/2026 indicated R3 missed medication Guaifensin oral liquid from 06/24-07/01/2026 due to medication not being checked in on time upon delivery to the facility. The resident had no after effects. Per physician report dated 09/07/2025, R3 has a primary diagnosis of Chronic Obstructive Pulmonary Disease.

Based on the observations made during today’s visit, deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided as well as appeal rights.