Facility Evaluation Report

Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a case management-other visit and met with Clinic Nurse, Gina Young. Administrator Nicole Paiste was contacted via phone call and gave permission for Clinic Nurse to sign and receive report.

LPA is following up on a self-reported incident report (IR) regarding medication mismanagement received by Community Care Licensing on 11/4/2025. Staff (S1) administered Client (C1) with an additional dose of Ativan during a PM med pass. C1 had already received the PM dose of Ativan, however, MAR was not updated resulting in the secondary dose. Administrator stated that staff involved have been pulled of medication and will receive a thirty (30) medication retraining course and will be assessed at the end of this course to decide if whether they wil return to medication administration.

Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. See LIC809D.

Exit interview conducted with Clinic Nurse, whose signature on form confirms receipt.