Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 3/11/24 at 10:45a to conduct an investigation of an incident where resident #1 possibly had a medication error and/or there was a records managment error in February 2024.

LPA met with Caregiver Ellen Fidel and stated the purpose of the visit. Ellen Fidel contacted the Administrator Cynthia Cruz-Maduro regarding todays visit. Administrator arrived within 15 minutes to assist with todays visit. LPA conducted interview with Administrator, and reviewed medication documentation for Resident #1 (R1).

Based on records review, documentation, and admittance of Administrator the investigation revealed that

the MAR was correctly handwritten but then incorrectly typed. However there was no medication error that occurred during the administration of medications.

Therefore, the preponderance of evidence standards has been met.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiencies are being cited on the attached 809D during this visit.

If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed.

The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. Exit Interview held and a copy was provided.