Facility Evaluation Report

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to follow up on an incident reported to Community Care Licensing. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Executive Director (ED) James Arp and Assistant Executive Director (AED) Donetta Johnson.

Community Care Licensing received an Incident Report on 5/21/25 in which it was reported that Resident #1 (R1) had been given another resident's medications by Staff #1 (S1). Per the report, once S1 noticed the error, they reported to the nurse on duty, who performed an assessment on R1. R1 experienced a change in condition and emergency services were called. R1 was evaluated by medical personnel in the hospital and cleared to return back to the facility the same day. R1's Responsible party and Primary Care Provider (PCP) were notified of the incident.

During today's visit, LPA conducted file review, a health and safety visit with R1, and provided consultation with ED Arp and AED Johnson.

A Deficiency was cited during the visit. An exit interview was conducted with ED James Arp to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.