Facility Evaluation Report

A Case Management visit was conducted to address deficiencies noted during Complaint Control #29-AS-20240813104110 investigation visit conducted during today’s visit. Upon arrival at approximately 11:08 am, observation revealed the “Ring” doorbell is not audible to staff present inside the facility and did not notify Administrator who was out of the facility at the time of LPA’s arrival. At approximately 11:58 am, Tracy Jackson, Lead Quality Assurance Specialist, Tri-Counties Regional Center (TCRC) confirmed the doorbell is not properly working. Witness 1 (W1) stated the battery needs to be charged and plugged the battery in to begin charging it. Administrator stated the issue is that the doorbell is not connected through the internet.

At approximately 11:45 am, LPA observed the kitchen floor with debris, candy wrapper, food particles, and a fork. S1 stated they are on duty one day/week and their duties include cleaning the facility. S1 stated they are the only staff who has the responsibility of cleaning the facility. At approximately 12:50 pm, LPA observed numerous items such as stacks of paperwork, boxes, surgical masks, decorations, and containers with miscellaneous items stacked amongst a couch, on the desktop, under counters, in corners, and along the wall leading into the facility.

At approximately 2:11 pm, LQAS and LPA observed medications in the refrigerator one box of Ozempic 20mg per dose, two boxes of Repatha 140MG/ML Sureclick 2=2 prescribed to Administrator and two boxes of Humalog Kwik-Pen insulin lispro injection with no label. Medications were observed unlocked on the refrigerator door and in the vegetable drawer.

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided at the time of the visit.