Follow-up·October 28, 2025

At approximately 11:55AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Other visit and met with Executive Director, Kimberly Humphrey. The purpose of today's visit was to conduct the facility's quarterly Non-Compliance inspection and to follow up on an incident report that was self submitted to Community Care Licensing (CCL). LPA reviewed files for staff members hired between July 2025-October 2025 related to the below concerns: Reporting Requirements Personal Rights Incidental, Medical, and Dental Care Welfare and Institutions Code Administrator and Designated Representatives LPA observed that identified staff members hired within this time frame had appropriate training documented. LPA followed up on an incident report that was submitted to CCL on 10/01/2025. Report states that on 09/25/2025, Resident 1's (R1's) medication was administered to Resident 2 (R2). Per report, both residents have the same medication with the same dosage. Residents were placed on 72 hour monitoring to observe for any adverse effects (deficiency cited, LIC809D, regulation 87465(a)(4)). Facility provided proof of training conducted on 09/25/2025 on "The Six Rights" related to the incident report. Deficiency cleared during visit and Corrections Letter provided. Continued on LIC809C Continued from LIC809 **An immediate civil penalty assessment in the total amount of $250.00 has been issued for a repeat violation of Regulation 87465(a)(4) more than once in a 12 month period. Regulation last cited on 01/23/2025.** (See LIC421FC) 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. Exit interview conducted. Copy of report, LIC809D, LIC421FC, Plan of Corrections, Appeal Rights, and Corrections Letter discussed and provided to Executive Director. Signature on form confirms receipt of documents.