Incident investigation·May 7, 2021

On 05/07/2021, Licensing Program Analyst (LPA) A. Walton conducted a Case Management-Incident visit via telephone due to COVID-19 and precautionary measures. LPA introduced self and requested to speak with Administrator. LPA met with Executive Director (ED), Kelly Metz and Resident Services Director (RSD), Kimberly Elderidge. The purpose of today's visit is to follow up on an Incident Report submitted to the Fresno CCL office on 04/23/2021. It was reported that on 04/18/2021 at approximately 8:00PM, S1 administered 10mg of Zolpidem to R1. R1's order states "Zolpidem 10mg", however, the description states to take 0.5 Tab by mouth". R1 received one 10mg tablet instead of the ordered 5mg/0.5 tablet. On 11/16/2020 and on 03/30/2021, LPA conducted a Case Management visit at the above facility. The facility was issued a citation on both dates based on California Code of Regulations Section 87465(a)(5) Based on today’s visit, a deficiency is being cited, per California Code of Regulations, Title 22, Division 6, Chapter 8 on the attached 809D. A Civil Penalty is being assessed in the amount of $1000 for Repeat Violation in accordance with the California Code of Regulations, Title 22 An exit interview was conducted and a Plan of Correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Kelly Metz, via email and an electronic read receipt confirms receiving these documents. Facility Representative signature on file.