Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai arrived unannounced to conduct a continuation of the annual inspection from 1/27/2024. LPA Rai met with Administrator (ADM) Elizabeth Bautista and stated the purpose of today's visit. LPA Rai observed 2 staff, including ADM and 4 residents at the facility.

On 1/27/2024, LPA Rai reviewed resident (R1)'s Centrally Stored Medication log and R1's medications. LPA Rai observed discrepancy in R1's medication administration record (MAR) for January 2024. 2 Of 13 medications were not administered to R1 as per physician's orders. LPA Rai and S1 counted medication #5 and 2 tablets were not administered to R1. LPA Rai and S1 counted medication #6 and 0.5 tablet was not administered to R1. Based on R1's MAR, R1 did not refuse medication and R1 was not admitted to the hospital after the medication bottles were opened.

During visit, LPA Rai reviewed facility records for 2 staff and 2 residents. During review of 2 of 2 resident files (R1-R2), files did not contain weight log observing resident's weight. ADM stated the facilty is not monitoring resident's weight. Based on record review, R1 has been admitted to the facility for 6 months and did not have any recorded weight log. ADM understood if the resident was not able to use weight machine to record weight, ADM can measure resident's arm and note under observation.

Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D.

87411 Personnel Requirements - General is being cited during today's visit. LPA Rai would like to clarify the facility personnel being in sufficient in numbers is not the concern, however the facility personnel's actions and documentation are observed to be not competent to provide the services necessary to meet the resident's needs.

Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Technical Violation was given. This report was reviewed with Administrator (ADM) Elizabeth Bautista. A copy of the report and Appeal Rights were provided.