Facility Evaluation Report

Licensing Program Analysts (LPAs) Christi Coppo and Ethel Contreras arrived at this facility unannounced to conduct a case management visit and was greeted by caregiver. Licensee on site but was not inside facility when LPA arrived. Licensee arrived inside facility later. LPA met with licensee Alex Varshavsky.

Upon entering the facility LPA observed caregiver alone in medication room. LPA asked if licensee was here and S3 responded yes but that they did not know where he was at, he was “some place around the facility.” LPA then observed S3 to exit the med room carrying a tray of medications. LPA asked S3 if they were going to pass the medications on the tray and S3 responded yes. S3 went on to start passing the meds on their own without licensee. LPA waited for licensee in the dining room. Licensee showed up about 15 minutes later. LPA asked licensee if S3 had completed their medication training in order to pass medications on their own. Licensee responded that he was still training S3. LPA asked licensee for S3’s medication training. LPA reviewed S3’s training records. LPA observed medication test present in S3’s file. LPA observed 1 hour of “Understanding California Medication Regulations,” completed on 2/21/25. No other documentation of medication training present. ( deficiency cited, see 809D ).

On 1/13/26 facility submitted an Incident Report (IR) for resident (R1) indicating that on 1/8/26 R1 was sent to the doctor and then the emergency room. However, IR did not indicate the nature of the event, symptoms exhibited or any cause for sending R1 to the emergency room, report did not provide description of any findings or treatment if any occurred at the hospital, or when/if R1 returned to the facility. On 1/23/26 facility submitted an IR for resident (R2) indicating that on 1/23/26 R2 was sent to the emergency room. However,