Incident investigation·August 10, 2022

On 08/10/22 at 1:25PM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving self-reported incident dated 08/02/2022 submitted to CCLD regarding medication error. LPA explained the purpose of the visit with general manager. Based on the record review and interviewed, LPA observed that resident R1 was given wrong medication Levothyroxine 100mg x1 tablet which belonged to resident R2. LPA spoke with R1, R1 stated that she didn't feel sick, however, staff still wanted her to be checked by doctor so 911 call was activated. R1's son-in-law arrived at facility before ambulance came then took R1 to hospital. LPA observed that the hospital discharge paper indicated "Hypotension due to drugs". Resident stated that she has not been having symptoms due to wrong medication since then. Due to no injury or medical issue was resulted to R1 as of today, no civil penalty is assessed. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809-D. Failure to submit proofs of correction (POC) by plan of correction due date and/or any repeat deficiency within a 12-month period may result in civil penalties . Exit interview conducted with general manager, appeal Rights and a copy of this report provided.