Facility Evaluation Report

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced Case Management visit. LPA met with Administrator (ADM) Jemanesh Duguma. The purpose of the visit was to address deficiencies found during a semi-annual review of the facility on 01/13/2026 by the Department of Developmental Services.

On 1/13/2026 the Department of Development Services (DDS) conducted a semi-annual review at the facility and observed duplicate entries for a medication (M1) for a resident, referred to as R1, upon reviewing the Medication Administration Record (MAR). DDS noted there were duplicate entries on 1/6/2026 for a medication administered to R1, resulting in R1 being administered M1 45 minutes earlier than ordered.

During today's visit, LPA reviewed R1's MAR and did not observe any additional discrepancies for M1, which was placed on hold 1/9/2026 per physician's order.

LPA reviewed the M1 bottle, which states the following "Take 10ML by GT four times daily as needed (cough) max 4 doses in 24 hours."

LPA reviewed staff training records for 2025 and 2026.

LPA also reviewed 1 staff record, and 1 resident record.

No deficiencies were cited per California Code of Regulations Title 22. An exit interview was conducted with ADM and a signed copy of this report was provided.