Facility Evaluation Report

Licensing Program Analyst (LPA'S) Kesha Lewis and Albert Johnson conducted an unannounced Case Management visit to follow up on an AWOL incident, which occurred on 10/31/22. LPA'S explained purpose of visit to staff.

On 10/31/22 Resident 1 (R1) AWOL'd from the facility, and showed up at his mother’s house on 11/04/2022. R1 had no medication from 10/31/22-11/09/2022. On 11/10/2022 R1 and his father came to pick up his medication from the facility. Medication errors in the form of missed medication doses have occurred on 10/31/22-11/09/2022 and R1'S Physician was not notified by the facility of the missed medication nor was the department sent an incident report regarding missed medication for R1. The medication administration record for R1 has not been filled out for the month of November up until today 11/29/2022. Copy taken.

LPA'S reviewed R1'S file and LIC 602 (Physician's report) and R1 is able to leave the facility unassisted. Copy taken.

LPA'S conducted a tour through facility with staff to check fire clearance. LPA'S observed the Ansul system had not be serviced since 1995. There is a annual inspection and a (5) five year inspection that should be conducted. Photo taken.

Deficiencies were observed and cited from the California Code of Regulations, Title 22.

Exit interview conducted with Staff and a copy of report was left at facility. Appeal rights given