Incident investigation·October 13, 2022

On 10/13/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a Case Management visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Director of Resident Services, Samantha Keith. The purpose of this visit is to follow up on an incident report that was submitted to the Fresno CCL office. It was reported that on 10/03/2022, facility staff pulled medications for R1 and R2 and administered all medications to R1. A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6, on the attached 809D. A civil penalty in the amount of $250 is being assessed for repeat violation. Exit interview conducted and a plan of correction was reviewed and developed with Director of Resident Services. A copy of this report and appeal rights were discussed and provided to Director of Resident Services, Samantha Keith, whose signature on this form confirms receipt of these documents.