Incident investigation·March 1, 2022

At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a case management visit in regards to incident reports submitted to CCL. LPA met with Executive Director Jessica Milich, toured the facility and reviewed records. Incident #1. Medication technician gave Resident 1 (R1) medication that was for a different resident. The error was immediately noticed and residents primary care physician was notified. Residents physician did not order any special precautions other than observe for reaction. Resident was currently prescribed one of the medications. Medication technician was given retraining on medication administration. Facility will conduct refresher medication administration training to all medication technicians. Incident #2. Facility reported several incidents regarding Resident 2 (R2), where they were aggressive to other residents and staff. Facility has documented each incident and has updated the care plan to address the new behaviors. Care plan addresses the need to have staff nearby while R2 is in common areas to ensure the safety of all. Facility has issued a lawful eviction to resident and their responsible party. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Director and Appeal rights were given.