Facility Evaluation Report

On 11/04/2024, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced regarding a case management. LPA Campbell asked for the file for Resident 1 (R1) and reviewed the Incident Report (IR) for the incident that occurred on 10/27/2025. Per the SCO 341, R1 called the front desk and asked for assistance and R1 stated had taken poison on purpose. When staff arrived, R1 stated they did not remember why had taken the hydrogen peroxide. When S1 asked why they had taken the hydrogoen peroxide, R1 said they had done it on purpose. The hydrogen peroxiide bottle was empty by the sink and the aspirin bottle was empty on top of the trash. 911 was called. When they arrived, EMS asked what the resident had done but R1 was unable to recount what happened.. R1 was also unable to tell the hospital when they arrived, what they had done . R1's son and physician were notified and R1 was taken to the hospital.

R1 was an independent living resident and did not need assistance with activities of daily living. (ADL). Per the most recent Physician's Report, R1 had a diagnoses of Depression with a secondary diagnoses of Mild Cognitive Impairment. The Mild Cognitive Impairment addition came on 03/2025. However, there was no change in the Physician's Report regarding restrictions for medication or other as needed drugs or chemicals.

Treatment consisted of two rounds of dialysis that were completed successfully at the hospital. Afterwards, the hospital determined R1 needed Memory Care which Samaritan does not provide. Along with Samaritan Viillage and a placement agency, a more appropriate facility was found. Once transferred to the new facility, R1's son reported that R1 had stated she had taken three aspirin and had used Hydrogen Peroxide for her hair.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 8, no deficiencies are being cited .