Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at Summer House for the purpose of following-up on an incident report that was forwarded to the Regional Office (RO). LPA was met by Administrator, Sam Young, and was granted access into the facility.

A facility tour was conducted on May 24, 2022 at approximately 2:10 PM. LPA reviewed the Special Incident Report (SIR) dated on April 11, 2022, reporting a medication error. The error occurred on 04/10/22 while S1 was dispensing medication. R1 was given the wrong prescribed medication during medication administration. Responsible party and prescribing doctor were notified of medication error. R1 was observed for possible side effects. No side effects were reported. LPA interviewed administrator, made observations and inspected the medication room and reviewed medication administration protocols. Various documents were reviewed including Centralized Stored Medication Record (CSMR), Medication log, staff training hours.

Deficiencies are cited from the California Code of Regulations (CCRs), Title 22. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with the Administrator and appeal rights were given.