Incident investigation·August 18, 2021

Licensing Program Analysts (LPAs) Hansen & Fernandes-Goes conducted an unannounced case management – incident and met with Stacy Vermeulen - General Manager & via phone Kehley McKenzie - Health & Wellness Director. The purpose of the case management visit was to obtain additional information regarding recent incident report that was self-reported by the facility. LPAs obtained more information on SIR submitted to CCL on 8/11/2021 that occurred on 8/8/2021 regarding resident R1 incident report medication error. Facility staff S1 dispensed medication Norco 10MG-325MG tablets on 8/8/21 and gave resident R1 2 tablets at 12:38 AM. Per doctors orders on file dated 8/3/2021, Norco 10MG-325MG take 1 tablet by mouth every 12 hours as needed for pain. Facility uses an electronic MARs (Medication Administration Records) to track and allow med techs to follow doctor's orders. According with lead med tech Ermi interview staff will have a red target on electronic MARs if trying to give a medication in the wrong time or quantity. Staff S1 didn't follow doctor's orders when resident R1 requested 2 Norco by dispensing 2 Norcos at once. (see copies on file, LIC 809-D) Facility is conducting medication training including shadowing lead med tech, and will be assessing staff S1 before allowing to return as med tech. In addition, LPAs requested training and records for staff med tech S1, and learned that staff S1 was hired on 12/4/2020. Facility wasn't able to provide proof of initial medication training due to change of leadership in the facility per general manager Stacy V. and Kehley - Health & Wellness Director. (see staff records on file, LIC 809-D) The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. Appeal of Rights Given.