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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610300
Report Date: 02/08/2023
Date Signed: 02/08/2023 03:29:37 PM

Document Has Been Signed on 02/08/2023 03:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:QUEST BEHAVIORAL HEALTH INCFACILITY NUMBER:
197610300
ADMINISTRATOR:MELIKYAN, ARMENFACILITY TYPE:
772
ADDRESS:43828 47TH STREET WESTTELEPHONE:
(661) 579-6666
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: DATE:
02/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Marine GuloyanTIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Evelin Rios conducted an announced Case Management visit to the facility mentioned above to follow up on an incident reported by facility on 1/22/2023. LPA met with Marine Guloyan the Program Director and staff #1 (S1) the LVN for he facility. Facility reported client #1 (C1) took the wrong medication. C1 was sent to the emergency room shortly after the incident. C1 was discharged from the emergency room and returned to the facility on the same day. A nurse ordered C1 to skip their morning dosage of medication. Since discharge, C1’s vitals were checked and reported within normal range. Executive Director has put into place new measures to prevent this incident from occurring again. The facility will require staff to double-check medication labels before handing them to clients. On 01/26/2022 LPA requested the following information from the Executive Director: medication logs for C1, a copy of facility medication policies, training records for the staff involved, and an internal investigation if any had been conducted.

Case Management was to follow up on the medication error. LPA reviewed the requested documents and other documents requested on todays visit. Staff #1 (S1) involved in the incident has CPR and First Aid certification up-to-date and on file. LPA reviewed C1's emergency room discharge instructions which revealed information stated in incident report to be accurate. Facility’s Medication Management states a qualified staff member will monitor the client during the self-administration of his/her medications. C1’s physician’s report states C1 can administer and store own medication. Staff responsible for monitoring has up to date Medication protocol training and there doesn't appear to be any neglect by facility staff as they responded immediately once it was determined client took the wrong medication and dose. Therefore, based on the information obtained no citations were issued. Staff was advised, and a copy of this report was given.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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