Incident investigation·February 7, 2024

This report is being amended to complete the visit for 02/07/24 to update the original POC and correct verbiage. Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced Case Management on 02/07/2024. The case management visit pertains to an incident report received on 12/04/2024. During the visit, the LPA met with Administrator Margaret Homa and collected documents pertinent to the incident report. LPA Campbell obtained R1's MAR for November and December, their 602 and their prescriptions for review. R1’s ID sheet was also utilized to confirm notification procedures. Per the administrator, the medication error that occurred on 12/01/23 was due to med tech error . LPA Campbell observed that the MAR reported that R1 received medication on 12/01/23. Per S2, the details of the med error were entered in the staff notes. No signature/initial key was provided on the back of the MAR to clarify the full name of which Med Tech passed out medication. The Med Tech who passed out the wrong medication for R1 could not be interviewed because they were out of the country. Based on LPAs observations and interviews the preponderance of evidence standards 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. This poses an immediate Health and Safety risk to residents in care. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. Exit interview held. The Licensee was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. A copy of todays’ report provided.