Facility Evaluation Report

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Case Management-Deficiencies visit to follow up on a deficiency cited on 9/11/2025. LPA also followed up on a self reported incident of a medication error reported to the Department on 7/30/2025. LPA met with General Manager (GM) J.P. Rollet. LPA stated the purpose of the visit.

The facility was cited the following Type A deficiency on September 11, 2025:

87468.1 Personal Rights: (a)(2), POC due 9/12/2025.

LPA received plan of corrections by POC date. Deficiencies cleared during todays visit. POC cleared letter provided to GM.

On 7/30/2025, the Department received an incident report regarding a medication error on 07/25/2025 involving Staff S1 giving resident R1 another resident's medication. The incident report states S1 reported the medication error to management, and 911 was called. R1 was taken for observation at the hospital, and returned back to the facility the same day with no injuries. The reports states R1 was monitored by staff for changes in condition after the medication error, and R1's family and primary care physician were notified.

During visit, LPA request copies of the following documents: Disciplinary Notice, In-Service Training Records, physician's reports, Service Plans, Centrally Stored Medication and Destruction Records, and Medication Administration Records (MAR).

LPA determined the medication error requires further investigation. No deficiencies were cited at this time as per California Code of Regulations Title 22. An exit interview was conducted with GM and signed copy of this report was provided.