Facility Evaluation Report

On December 17, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit in relation to complaint control #: 14-AS-20251112101102. LPA met with Caregiver, Alex Lumbera and explained the purpose of the visit.

During the complaint investigation, LPA reviewed facility's centrally stored medication record and conducted medication count for Resident 1-4 (R1-R4). LPA did not conduct medication count for Resident 5 (R5) as according to staff interviewed and documents reviewed, R5 is on hospice and the facility does not administer medication to R5. Based on centrally stored medication record reviewed for R1-R4, the facility failed to ensure that the centrally stored medication record was updated and corresponded with the residents' medication list as prescribed by the physician. In addition, when conducting medication count, LPA observed the amount of medications in the bottle did not correspond with the start date of the medication listed on the centrally stored medication record.

Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with the Facility Manger and a copy is provided with appeal rights.