Facility Evaluation Report

Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted an unannounced case management – legal/non-compliance visit. The purpose of today’s visit is to ensure the facility is maintaining substantial compliance. Upon arrival, the LPAs met with Facility Designee Agnes Gazaryan and explained the reason for the visit. LPAs were informed Administrator was not available during today's visit. The LPAs focused today’s visit on physical plant and medication administration in compliance with Title 22 Regulations.

During today's visit, the LPAs, along with Facility Designee, conducted a physical plant tour beginning at 12:37PM and LPA Dulek conducted a medication review at 01:47PM. The following was noted:

During the physical plant tour, LPAs observed feces in a planter in the outdoor area of the memory care unit. An unidentified brown substance was observed on the wall above the planter area where the feces was observed. Additionally, a hose was observed running down the outer wall of the memory care unit. Maintenance Director stated the gutter was damaged and fell off the wall during a recent storm. LPA Dulek reviewed medications for four (4) residents. Resident #1 (R1)'s medication trazodone 100mg was signed as administered, however was not popped from the bubble pack for one (1) day. For Resident #2 (R2), Rosuvastatin Calcium 20mg is initialed as administered, but was not found. All four (4) residents reviewed appeared to have medications administered for the 22nd during the day and the night shift on the 24th and 25th, however, they were not initialed as administered on the Medication Administration Record.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Civil penalties issued in the amount of $500, for repeat violations. Facility Designee was informed that failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted. A copy of today's report was provided via email.