374601035-12-6-2024-08-AS-RARZ-DBPSMU-20241206130030

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374601035
Report Date: 12/06/2024
Date Signed: 12/06/2024 01:00:37 PM

Document Has Been Signed on 12/06/2024 01:00 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	LUCY'S PLACE		FACILITY NUMBER:	374601035
ADMINISTRATOR/ DIRECTOR:	LUCIA B.TOTANES		FACILITY TYPE:	740
ADDRESS:	4770 ELM TREE DRIVE		TELEPHONE:	(760) 806-3873
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	12/06/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Caregiver Edessa Dietsch		TIME VISIT/ INSPECTION COMPLETED:	01:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Edessa Dietsch. LPA spoke with Caregiver Victoria Dao via telephone during the visit. Licensee Lucita Totanes arrived during the visit. During today's visit, LPA toured the facility, reviewed facility records, and observed resident in care. During the facility tour, LPA observed a resident's medications were stored in a weekly pill box and medication cup and not in their original container. Additionally, the pill box and cup were stored in an unlocked cabinet drawer in a common room of the facility. LPA observed Caregiver Dietsch relocate the pill box and cup into the locked medication cabinet during the visit. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. The following deficiencies were cited for medications not stored in their original container and unsecured medications and noted on the attached LIC809-D page. An exit interview was conducted with Licensee Lucita Totanes, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

Jennifer Lott	TELEPHONE: (619) 346-3976
Rebecca A Ruiz	TELEPHONE: (619) 318-7620
	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

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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Document Has Been Signed on 12/06/2024 01:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: LUCY'S PLACE	FACILITY NUMBER: 374601035
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited above in that 1 of 1 resident's medications are stored in a weekly pill box and medication cup, which poses a potential health risk to 1 of 1 residents in care.
	POC Due Date: 12/31/2024
	Plan of Correction
1 2 3 4	Licensee will instruct caregivers to give resident medications directly from the pill bottle and not from the pillbox and to not pre-pour medication. Licensee will have caregivers participate in vendor training on medication storage and administration and will submit copies of the certificate of completion to the Department by POC due date of 12/31/2024.

Section Cited

87465 Incidental and Medical Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited above in that a pillbox and medication cup containing 1 of 1 resident's medications was stored in an unlocked cabinet located in a common area of the facility, which posed a potential safety risk to 1 of 1 residents in care.
	POC Due Date: 12/31/2024
	Plan of Correction
1 2 3 4	LPA observed Caregiver Dietsch lock the medications contained in the pill box and medication cup in the locked medication cabinet during the visit. Licensee will instruct caregivers to store the medication in the locked medication cabinet. Licensee will have caregivers participate in vendor training on medication storage and administration and will submit copies of the certificate of completion to the Department by POC due date of 12/31/2024.

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

Jennifer Lott	TELEPHONE: (619) 346-3976
Rebecca A Ruiz	TELEPHONE: (619) 318-7620
	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

LIC809 (FAS) - (06/04)

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