Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa (JN) arrived at Davis Summer House to conduct a Case Management visit regarding a self reported incident that was sent to CCL on 10/11/2021.

LPA spoke with Administrator, Maira Gurrola. It was reported that on 10/07/21 Resident (R1) reported that they had been menstruating, explaining "I haven't had my period since before my depo shot". Facility contacted R1's advice nurse and discovered R1 had missed prescribed Depo-Provera injection. Facility arranged for R1 to receive Depo-Provera injection on 10/11/21, at 1:10 PM. Her next injection has been scheduled for December and has been logged on facility's calendar

Administrator stated that each resident has an advocate assigned to help them access medical and dental appointments, and this particular appointment was mis-documented by previous advocate (who has since been reprimanded and removed from those duties), nonetheless Licensee failed to ensure that client/resident received necessary medical services.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.