Facility Evaluation Report

Licensing Program Analysts (LPAs) Angela Hood and Michael Hood arrived at the care home today and met with the Administrator, Chanese Thomas. The purpose of today's visit is to conduct a case management visit regarding incident reports received by CCLD. The facility currently does not have any COVID-19 positive cases. LPAs were screened upon entry in the care home and wore N95 masks. All staff wore masks in the facility.

On 10/1/21, an incident report was received regarding resident (R1) missing a dose of medication on 9/30/21. Assistant Director contacted facility's RN and R1's physician was contacted as well. According to incident report, there did not appear to be any consequence to R1 as a result of the omission of medication.

On 10/11/21, CCLD received an incident report indicating that resident (R2) had a medication omitted by error on 10/9/21 that was discovered on 10/10/21. R2's primary care physician was contacted. The report indicates that there did not appear to be any consequence to R2 as a result of the omission of medication.

During today's visit, the Administrator provided two additional incident reports that were emailed to the previously assigned LPA.

On 9/17/21, it was identified by facility staff that R2 had a missed medication on 9/16/21. R2's primary care physician and psychiatrist were contacted and both indicated that there were no concerns or follow-up needed regarding the missed medication.

On 10/31/21, a medication audit was conducted and facility staff found that R1 missed medication on 10/30/21 in error. Staff members (S1 and S2) involved in the omission of medication were removed from

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