Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to do a Case management visit regarding a self reported medication error on R1. R1 went on a visit to family, and the facility inadvertently administered the wrong medication upon return. Staff involved in the medication error is no longer employed

Client Advocate 1 was retrained by the Program Manager on Medication Administration. Program Manager and Medication Manager have assumed sole responsibility of reviewing and complying R1'S medication schedule to reduce medication errors while advocate 1 was retrained. There have been no reported medication errors since the re-training and review and compilation schedule has been enacted.

No deficiencies were cited during today's visit.