Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 7/11/24 at 9:10a to obtain additional information regarding an Incident report received on 6/14/24. LPA met with Gabrielle Berard, Office Coordinator and stated the purpose of the visit.

The incident report indicated that on 5/25/24 there was 3 missed medications by Resident #1(R1) due to R2 having a behavior. Community Care Licensing (CCL) also received notification that the Licensee did not notify Regional Center (RC) of the incident until 5/30/24. LPA observed that CCL received the incident report on 6/14/24, 20 days after the incident and RC received their report 5 days after the incident.

CCL also received an incident report for a medication error on 6/23/24 for R2. During this error, S3 noted medication was passed on the MAR but the medication was still present in the bubble pack. An interview with S3 concurred that the medication was missed during the shift.

During todays visit, LPA interviewed Staff #1 (S1-S3). Based on the interviews, S1-S3 concur that R1 and R2 missed medications with no adverse reactions and physicians were notified.

Per CCR Title 22, Div 6, Ch1, the following deficiencies are 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 with a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights.

An exit interview was held. Copy of this report provided.