Facility Evaluation Report

On 06/27/2022 at 2:30 PM, Licensing Program Analyst (LPA) T. White arrived unannounced to conduct a case management visit regarding medications. LPA met with Adminstrator, Umer "Ali" Qureshi, and explained the purpose of the visit.

LPA reviewed 5 clients Medications Administration Records (MARs). Based on documentation, 4 of 5 clients medications were missed on 06/25/2022 and 06/26/2022. 1 of 5 clients medications was missed only on 06/26/2022. Based on clients bubble pack medications, medications were administered on 06/25/22022 and 06/26/2022. LPA interviewed 4 staff members. 4 of 4 staff stated clients medications were administered on time. However, Staff #5 (S5) did not sign the MARs to show clients received their medication.

The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties.

Exit interview conducted with Administrator. A copy of report and appeal rights given.