Facility Evaluation Report

Licensing Program Managers (LPMs) Robyn Clark and Lizzette Tellez conducted an unannounced case management deficiencies visit. LPMs were met by Staff 1 (S1), Evangeline Pingul, and were granted entry into the facility. The purpose of the visit was discussed with facility staff.

While exiting the facility after a case management visit, LPMs observed Staff # 8 (S8) administering an injection to Resident # 5 (R5) in their abdominal area. Interview with S8 and review of staff records revealed that S8 is not an appropriately skilled professional, and is therefore not qualified to administer injections to residents in care.

Several hazardous items were also observed throughout the facility, which included rubbing alcohol and injection needles left unattended in the main living area, as well as Lysol in the bathroom. Three residents were awake and present.

LPMs left the facility at 11:18 a.m, and conducted an in-office meeting with the Licensee to discuss immediate plans of correction.

Deficiencies were cited under California Code of Regulations, Title 22 and noted on the attached LIC 809d. A copy of this report, along with Licensee/Appeal Rights was provided to Licensee Zayden Chen. Their signature on this form acknowledges receipt of this report and their rights.