Incident investigation·August 11, 2022

On 08/11/22 at 11:35 AM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving 2 self-reported incidents submitted to CCLD regarding mediation error. LPA explained the purpose of the visit with business manager, General Manager Angeles Sticka arrived at a later time. Based on records review, the following incident reports were submitted to CCL: On 4/28/2022, facility self-reported administered wrong dosage of medication Lorazepam to resident (R1) at 7:20am on 4/20/2022. R1 was not resulted injury or medical problem due to this incident. In-service training was provided to staff (S1) on 4/21/2022. On 7/12/2022, facility self-reported administered wrong dosage of medication Hydrocodone to resident (R2) at 5:00pm on 7/10/2022. R2 was not resulted injury or medical problem due to this incident. In-service training was provided to staff (S2) on 7/17/2022. On 8/1/2022, LPA advised LVN (S3) to retrain all med-tech. S3 submitted proof of training to CCL on 8/4/2022. Due to medication error occurred twice in 90 days, 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 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.