Facility Evaluation Report

Licensing Program Analyst (LPA) Nakagawa conducted an unannounced case management inspection. LPA arrived to the facility and was greeted by Administrator Mark Reyes. Mirabel Samoya, Resident Care Coordinator (S2) was contacted to conduct today's inspection at 10:10 AM. The purpose of this case management inspection is to follow up on a self reported incident report submitted to Community Care Licensing (CCL) on 08/08/2025.

CCL received an incident report reporting a medication error on 08/06/2025 occurred. Staff (S1) reviewed MARS 08/06/2025 and notified S2 that R1 had received a medication that had been discontinued that same morning. Doctor and family were contacted after medication error. 911 was called due to R1 experiencing some side effects. LPA was informed by S2 that S1 and all other staff handling medications received medication training regarding "Patches and Medications" on 08/07/2025.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal Rights Given.