Incident investigation·January 8, 2025

On 01/08/2025 LPA Gorban visited the facility to conduct health and safety checks of clients in care. LPA introduced self, stated the purpose of the visit and was allowed entry. Administrator was notified of Licensing visit and was able to attend it. During this visit LPA toured inside and outside of the facility, interviewed facility staff and administrator. This visit was conducted in regard to incident report provided to Licensing office that occurred on 12/28/2024 were medication error occurred. During this event resident (R1) was provided and taken wrong medications. Based on file review and interview of facility staff, responsible party was notified and resident was monitored. No adverse side effects observed during monitor period. Based on interviews and records reviews the deficiency cited on attached LIC809-D in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8. Failure to correct the deficiency, or repeat violations, may result in civil penalties. Exit interview with Appeal Rights (LIC 9058) and a copy of this report was provided for facility records.