Facility Evaluation Report

At approximately 9:00am, Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Case Management and met with caregiver. Administrator Christina The was not available, but contacted via telephone. Administrator gave caregiver permission to sign report.

On 7/3/2024 CCL received an incident report for medication error that occurred on 6/29/24 and 6/30/2024. The Incident report states that resident (R1) returned to facility from hospital with Glipizide XL 20mg medication that was not entered into the MAR and therefore not administered on 6/29/24 and 6/30/2024. NOC shift lead noticed the error and notified the AM lead. AM lead corrected the MAR immediately upon being notified of the error. Facility immediately notified R1's doctor of medication error. Facility monitored R1 for adverse effects; no adverse effects or changes observed due to medication error. Per Administrator, the facility conducts training on medication management on an on-going basis, but has not conducted training after this incident occurred. Facility will conduct training on medication management as part of plan of correction.

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

Exit interview conducted with caregiver and a copy of this report was given .

**An Immediate Civil Penalty in the total amount of $250 is being assessed for repeat violations of Regulation 80075(b) for occurring more than once in a 12 month period. (See LIC421FC)**