Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management – Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with DSP Angelica Marin. LPA also spoke via phone with Administrator Cesiah Serrano during the visit.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office on 07/17/2023. According to the LIC624: from 06/25/2023 through 06/30/2023, Client #1 (C1) did not receive four (4) of their prescribed routine medications. [See LIC 811 Confidential Names List for a description of C1]. The missed doses did not result in any adverse health consequence for C1. On 07/14/2023, Licensee became aware of the above discrepancies.

During today’s visit, LPA performed a brief facility tour and welfare check on C1, verifying that they and their peers were safe. LPA also reviewed pertinent care records and interviewed relevant staff.

Staff interviews revealed additional context which was material to CCLD’s analysis/evaluation of the incident. No deficiencies were observed or cited during today’s visit.

However, LPA provided a Technical Assistance regarding medication assistance under 80075 Health Related Services (refer to the LIC 9102-TA). LPA also provided education to Licensee regarding forms LIC613 (Client’s Personal Rights) and LIC621 (Client/Resident Personal Property and Valuables).

An exit interview was conducted with Serrano and Marin, to whom a copy of this report, the LIC 9102-TA, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.