Facility Evaluation Report

On 01/23/2025, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct a case management inspection. LPA met with administrator Dora Rodriguez and announced the purpose of the inspection. LPA's toured the facility inside and outside.

This inspection was conducted to follow up on an incident which facility staff reported to the department on 01/17/2025. On 01/17/2025 staff discovered that Resident 1(R1) did not receive a dose of his medication (Depakote ER) on 01/13/2025. R1's primary care provider was notified and no adverse effects were observed.

See attached LIC-809D for a Type-B Citation issued in accordance with California Code of Regulations, Title 22, Division 6, Chapter 1. See attached LIC 421FC for civil penalty issued due to repeat violation of CCR 80075(b). A copy of the reports and appeal rights were provided to the licensee.

Exit interview conducted, report signed and copy of this report with appeal rights provided for facility records.