Facility Evaluation Report

On April 29, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit in relation to an incident that occurred on April 20, 2025. LPA met with Administrator, Jose Acumabig and explained the purpose of the visit.

On April 23, 2025, the Licensee reported on April 20, 2025, the AM shift Med-Tech did not administer Resident 1's (R1's) Lacosomide (100mg) medication at 8am.

During the visit, LPA interviewed staff, reviewed R1's file and medication administration records (MAR). According to staff interviewed, it was acknowledged that the AM shift med-tech did not administer R1's medication on 4/20/25 at 8am.

Based on R1's physician's order, R1 is required to take 1 tablet of Lacosomide (100mg) medication daily at 8am, however based on the MAR, the med-tech did not administer the medication to R1. The facility failed to provide R1's medication as prescribed by the physician.

Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties. A civil penalty of $250.00 is issued today for a repeat violation within the last 12 months.

Report is reviewed with the Administrator and a copy is provided with appeal rights.