Incident investigation·June 18, 2021

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Jim August to follow up on an incident reported to Community Care Licensing. LPA met with Reminiscence Coordinator Viola Kaake and explained the purpose of today’s visit. Incident was self reported on 06/09/2021 regarding resident 1 (R1’s) incident on 06/08/2021. It was reported that staff 1 (S1) erroneously missed a dose of medication for R1 on 6/8/2021. The medication was Carbidopa and Synthroid. This was a single occurrence. R1 was noted to be ok and the facility notified family and her PCP. S1 was pulled off duty and will be taking additional classes, in service training and one-on-one training at the facility for observations. LPA found that facility acted appropriately and in a timely manner to address the incident and all other immediate attention to incident in question. LPA did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.