Senior Care Records.

Facility Evaluation Report

Kimaya Home, South San Francisco11/01/2023Licence 415600936

Capacity4
Census4
Date signed11/01/2023 02:49:48 PM
The inspector’s account

On 11/1/2023, Licensing Program Analyst (LPA) Grace Donato conducted a case management visit concerning an incident report received on 10/30/23. LPA met with House Manager Army Nagum and explained the purpose of today's visit.

On 10/30/23, facility submitted an incident report concerning a resident (R1) was given a wrong medication.

In regard to the incident, stated that on the day the incident occurred, the staff (S1) was managing two residents that morning. S1 accidentally gave the wrong medication to R1. After noticing the accident, S1 called Poison Control and was advised to monitor and observe the resident. R1 stayed at home and per advise.

R1 is currently doing well and didn't have adverse side effects.

Facility is currently scheduled for In-Service staff training regarding medication administration. Proof will be sent to LPA once finished.

No deficiency cited today. Report is reviewed and copy is provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction