Facility Evaluation Report

On 12/21/2023, at 2:15pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a case management visit. LPA met with the facility assistant administrator/direct care staff, Hayat Hassen, and explained the purpose of the visit. The administrator was informed of the visit and gave permission for Hayat to sign this report. During this visit, present were three (3) clients in care with two (2) staff on duty.

This visit is to cite deficiencies as noted during a Title 17 Monitoring Review conducted on 10/30/2023 by Alta California Regional Center (ACRC) representatives. The Department was made aware that a medication error was found substantiated during a medication review. ACRC representatives noted the absence of staff signatures on 3 of 3 clients’ Medication Administration Record (MAR) from October 29, 2023, to the morning dose on October 30, 2023.

Based on documentation review, the facility has complied with the correction plan noted in the Title 17 Monitoring Review report by the stated deadlines of 11/20/2023, 11/27/2023, 12/4/2023, and 12/11/2023.

Based on LPA’s observations and interview with the facility administrator, the preponderance of evidence standards has been met.

Per California Code of Regulations, Title 22 Division 6, deficiencies are being cited during this visit.

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

An interview was held with the facility assistant administrator, Hayat Hassen, and a copy of this report and appeal rights were provided.