Facility Evaluation Report
On 10/22/25, Licensing Program Analyst (LPA) Gorban conducted an unannounced case management deficiency inspection regarding incident reports that received from the facility. LPA met with Dora Rodriguez.
The purpose of the today's visit is to address a medication error. Facility reported medication error that occurred on 08/24/25 at 07:30PM, C1 received wrong medications: Clonazepam 0.5mg 1 tablet, Memantine HCL 10 mg 1 tablet, Hyoseyamine 0.375 mg 1 tablet, Melatonin 5 mg 3 tablets.
Another incident occurred on 10/05/25 when staff during routine cleaning found medication vitamin D3 supplement (1 tablet) which is a part of prescribed morning medications for C2. Pill was disposed accordingly following protocol. No side effects observed in both cases and medical professionals were notified.
A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached LIC 809D in the area of Health related Services . A civil penalty is being assessed see attached LIC 421IM Repeat.
Exit Interview conducted. A copy of this report and appeal rights was provided to Administrator, whose
signature confirms receipt of this report.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction