Facility Evaluation Report
Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management-incident visit in regards an incident report, regarding a medication error and a follow up visit for deficiencies cited on January 16, 2025. LPA met with staff (S1), Victoria Agnes. LPA explained the purpose of the visit. LPA spoke with ADM Catherine Koen who stated she was not available and stated staff S1 could sign on her behalf.
On February 13, 2025, the Department received an incident report, regarding resident R1. The incident report stated the following, “On Wednesday February 12,2025 Admin was informed and reminded by staff of a medication error that Admin was responsible for filling for R1.”
LPA spoke to ADM Catherine Koen, who stated she and the facility administrator were not available. ADM Caherine stated she is driving and cannot explain at the moment what had occurred regarding the medication error.
LPA received copies of R1's IPP and physician's report. LPA informed ADM Catherine Koen, that LPA would follow up on the medication error, during a follow up visit.
On January 16, 2025, the facility was issued the following citations during a case management - deficiencies. The deficiencies cited had a POC due date of January 23, 2025 for the Type B deficiency.
The following deficiencies were cleared during visit,:
Type B- 80086 Alterations to Existing Building or New Facilities (c)
No deficiencies cited during today's visit. This report was reviewed with Staff Victoria Agnes and a copy of the signed report was provided. Appeal rights were provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction