Facility Evaluation Report

On 05/13/25 ,Licensing Program Analyst (LPA) Talwinder Bains arrived at the above to conduct a Case Management visit regarding an incident that occurred on 04/23/25. LPA met with Program Administrator, Latisha Woodson and explained the reason for the visit.

Alta California Regional Center Special Incident Report (SIR) submitted by facility on 04/24/25 to CCL stated that on 04/23/25, around 11:30 PM, staff 1 (S1) noticed during medication count and reported to management that one tablet of clonidine 0.1 mg was not given to resident on 04/23/25 for 8PM dose, R1 as ordered by their physician.

Based on incident report, staff interviews, medication record review, it has been concluded that staff did not administer R1s prescription medication, clonidine 0.1 mg to R1 as prescribed by R1s physician. Facility notified R1s physician, CCL, ALTA and other agencies regarding this medication error on 04/24/25.

Based on this information, deficiencies are cited pursuant to California Code of Regulations, Title 22, Section 80075(b)(5)(B) and documented on the attached LIC809D. Immediate Civil penalty of $250.00 was assessed on LIC421FC today due to repeat violation of the same regulation within 12 months.

The report was reviewed, appeal rights, LIC809G and a copy of this report was left at the facility.