Facility Evaluation Report

On 05/23/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak conducted a case management visit. LPA met with Administrator, Madelyn Rojo and explained the purpose of today's visit. The purpose of today's visit is to follow up on a Special Incident Report (SIR) that was sent to the Department on 05/17/2024.

SIR indicated Alta California Regional Center (ACRC) conducted a Title 17 review on 05/16/2024 and notated a substantial inadequacy regarding medication. SIR notated Resident #1 (R1) medication Scopolamine Patch 1 MG (Apply every 1 patch to clean dry area of skin every 72 hours for excessive drooling) had been signed on the Medication Administration Record (MAR) for every five (5) days. Facility contacted the doctor as soon as this was observed, and no further medical attention is needed due to this error.

This home is required to be in compliance with both California Code of Regulations, Title 17 and Title 22. LPA's visit today is to address the issues found during the Title 17 review and issue deficiencies for the medication error.

Deficiencies are cited pursuant to California Code of Regulations, Title 22, and documented on the attached LIC809D. Failure to submit Proof of Correction (POC) by Plan of Correction date may result in civil penalties.

Exit interview conducted and a copy of the report and appeal rights was left at the facility.