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25 | Licensing Program Analyst(LPA) Christine Yee conducted a case management visit due to the deficiencies observed during a visit to the facility today. LPA Yee met with Eva Elizalde, Staff. Also present during the visit was Viktorya Hayrapetyan, Consultant. The reason for today's visit was explained.
The following deficiencies were observed on today's visit:
- Per review of Resident #1's file, it was observed that the PRN Authorization letter for PRN medications - Nitroglycerin .4 mgs and Acetominophen 500mg was incomplete. The PRN Authorization letter does not state if the prescribing doctor has determined that resident is able to determine his/her need for prescription and non-prescription medication on a PRN basis it does not list the PRN medications prescribed to resident and is not signed by the doctor.
- The facility does not retain copies of the physician's order for all the residents centrally stored medications.
- The Licensee did not report Resident #1's, 911 calls for service and on 12/14/24, 12/27/24, 1/3/25 and 1/8/25 and the 911 call and hospitalization on 12/18/24 - 12/22/24. A copy of the LIC624- Usual Incident/Injury Report was provided for 12/14/24 and 1/8/25 for the 911 calls and was supposedly mailed to Woodland Hills office. Licensee was unable to provide evidence of the mailing.
Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8.
Eva Elizalde, Staff left the facility around 3:15pm due to a family emergency and Viktorya Hayrapetyan, Consultant left around 3:42pm .
Exit interview was conducted with Flora Galoyan, Staff, as authorized by Eva Elizalde. |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
01/20/2025
Section Cited
CCR
87465(b)
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7 | Incidental Medical and Dental Care: If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self administrator of his/her PRN | 1
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7 | Licensee will review Section 87465 and state in writing that the section was read and understood and will comply with the section. Licensee will also review all residents' files and contact the prescribing physician to obtain completed PRN authorization letters for PRN |
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14 | medication. This requirement was not met as evidenced by: Resident #1 is prescribed with Nitroglycerin and Acetaminophen and there is no completed PRN Authorization Letter from the physician to indicate that the resident is able to determine his/her need for the PRN medication. | 8
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14 | medications prescribed to the resident.and maintain in the resident's file by 1/20/25 |
Type B
01/20/2025
Section Cited
CCR87465(e)(1-4)
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7 | Incidental Medical and Dental Care: For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. | 1
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7 | Licensee will contact the prescribing physician and obtain a signed, dated written order from a physician, on a prescription blank for all medications centrally stored and maintain in the residents' files by 1/20/25. |
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14 | Both the physician's order and the label shall contain at least all of the following information: 1. specific symptoms which indicate the need for the medication 2. The exact dosage, 3. minimum #of hours between doses 4. Maximum doses allowed in 24 hours. Facility does not retain physician's orders for medications
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
01/14/2025
Section Cited
CCR
87211(a)(1)(D)
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7 | Reporting Requirements: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. D) Any incident which threatens the welfare, safety or health of any resident, | 1
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7 | Licensee will review Title 22 Section 87211 and provide a written and signed statement that the section was read and understood and that they will comply with the section. Licensee will also fax or email a copy of the required LIC624 to the centrally monitored fax line or email address noted below |
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14 | such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. The Licensee did not report 911 calls for service for 12/14/24, 12/18-12-22-24, 12/27/24, 1/3/25, and1/8/25
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14 | (818)596-4376 or ccldascpwoodlandhillro@dss.ca.gov by 1/14/25 |
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