Incident investigation·November 8, 2022

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 11/8/22 at 10am to conclude an investigation regarding a Special Incident Report (LIC624) that was submitted to the Department on 9/28/2021 that indicated there was a medication error on 9/19/2021. LPA was met by Dominique Matsuhiro-Cea, Office Coordinator and Stacy Sharp, Resident Care Manager and stated the purpose of the visit. This is a continuation report from the Community Care Licensing (CCL) visit conducted on 5/16/22. LPA reviewed documents for Resident#1 (R1-R2) such as print outs from PointClickCare system dated 5/17/22. In addition, LPA was furnished with a facility laptop to review resident records on the PointClickCare system during this visit. This investigation revealed that Resident #1 (R1) was missing medication (Hydrocodone w/Acetaminophen) because it was mistakenly administered to R2. LPA also observed a copy of a hand-written document that staff was provided an in-service training regarding medication errors on 9/19/21. In addition, LPA received information that the staff involved is no longer working for the facility. Based on documentation review, the preponderance of evidence has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Resident Care Manager was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was provided during this visit.