Facility Evaluation Report

On May 6, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit in relation to an incident that occurred on 4/26/25. LPA met with Administrator, Jose Acumabig and explained the purpose of the visit.

The Licensee reported on 4/26/25, the PM shift med-tech administered an incorrect dose of Lacosamide to Resident 1 (R1). R1 is required to take 150mg of Lacosamide, however only 100mg was provided.

During the visit, LPA reviewed R1's file, including but not limited to; physician's orders for medication, medication list, centrally stored medication record, medication administration record (MAR).

Based on R1's physician's order, R1 is required to take 1 tablet of Lacosomide (150mg) medication daily at 8pm, however based on the MAR, the med-tech administered 100mg of Lacosamide instead of 150mg of Lacosamide. 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.