370804527-5-10-2023-08-AS-DPOL-CSCTE5-20230531143923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804527
Report Date: 05/10/2023
Date Signed: 05/10/2023 04:04:05 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/03/2023 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20230503121308

FACILITY NAME:	LIWAG'S RESIDENTIAL CARE HOME		FACILITY NUMBER:	370804527
ADMINISTRATOR:	NORA B. LIWAG		FACILITY TYPE:	740
ADDRESS:	3993 CASEMAN STREET		TELEPHONE:	(619) 690-1022
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY:	6	CENSUS: 4	DATE:	05/10/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Administrator, Nora Liwag		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Staff did not administered medication as ordered

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint investigation visit to open an investigation and deliver findings on the above allegation. LPA was granted entry by Administrator, Nora Liwag to whom she discussed the purpose of the visit.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff. It was reported staff did not administer medication for one resident (R1) [an LIC 811 Confidential Names List was provided to staff to identify the resident], as prescribed. It was specifically alleged that staff crushed and disguised medication in R1’s food. Review of R1’s medication records indicated the medication was to be administered three (3) times per day. A detailed audit of the medication records for the period between February 2, 2023, to May 2, 2023, indicated the psychiatric medication in question was administered three (3) times per day.

(continue LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230503121308

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LIWAG'S RESIDENTIAL CARE HOME	FACILITY NUMBER: 370804527
	VISIT DATE: 05/10/2023

NARRATIVE

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(continue from LIC9099)

However, during interviews the staff stated they crushed and mixed the medicine in R1’s food because the resident did not want to take it. Staff reported they tried to encourage R1 to take the medication but that R1 still did not want to take it. In addition, staff stated they had consulted with R1’s medical provider regarding R1 refusing to take medication, however, there was no physician’s order to crush medication.

The Department has investigated the above-mentioned allegation and has found that there was sufficient evidence to show facility staff were not administering medication as prescribed. Therefore, this allegation is deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099D. A plan of corrections was developed with Administrator, Liwag.

An exit interview was conducted with Administrator, Liwag and a copy of this report, Confidential Name List (LIC 811), the LIC9099D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided at the conclusion of the visit.

An exit interview was conducted with Administrator, Nora Liwag, to whom a copy of this report, LIC9099D, and LIC811 Confidential list form and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230503121308

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LIWAG'S RESIDENTIAL CARE HOME	FACILITY NUMBER: 370804527
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/31/2023 Section Cited CCR 87465(C)(2)	1 2 3 4 5 6 7	87465(C)(2) Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Licensee agreed to conduct in service training on medication management. In addition, licensee will obtain a doctor’s order to crush medication or stop crushing medication if a physician’s order is not obtained. Documentation of physician’s order and of completion of training should be submitted to CCL by POC date of 5/31/2023.
	8 9 10 11 12 13 14	Based on observations, interviews and records review, facility staff did not administer medications in accordance with physician’s orders for R1, which posed a potential health and personal rights risk to 1 of 4 persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC9099 (FAS) - (06/04)

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