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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602902
Report Date: 01/22/2025
Date Signed: 01/22/2025 04:50:02 PM

Document Has Been Signed on 01/22/2025 04:50 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LYN'S HOME CARE IIIFACILITY NUMBER:
374602902
ADMINISTRATOR/
DIRECTOR:		ABILLE, LYDIAFACILITY TYPE:
735
ADDRESS:186 MOSS STTELEPHONE:
(619) 426-2804
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 6CENSUS: 4DATE:
01/22/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Licensee Lydia "Lyn" AbilleTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite a deficiency identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Lydia “Lyn” Abille.

According to California Code of Regulations, Section 80075, medications which are centrally stored “shall be stored in [their] originally received container” and “no medications shall be transferred between containers.”

LPA observation of the facility’s medication cart, confirmed by interviews of multiple facility staff, showed: Prior to CCLD's intervention, Licensee’s standard practice was to remove clients’ centrally stored medications from their labeled blister packs (i.e., the packages in which the pills/tablets arrived from the pharmacy), up to three (3) days in advance of administration time, and to transfer them to plastic cups. These cups were not labeled with either clients’ names or other identifying information. These cups were then stacked directly on top of one another. Multiple stacks of cups were observed beside each other, within the same drawer of the facility’s medication cart, pending medication administration.

The above deficient practice was applied to the four (4) clients in care. On 01/15/2025, this practice materially contributed to medication errors by made Staff #1 (S1) and impacting Client #1 (C1), for which Licensee was separately-cited as part CCLD’s complaint investigation. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Lydia “Lyn” Abille, to whom a copy of this report, the LIC 809-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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 01/22/2025 04:50 PM - It Cannot Be Edited


Created By: Dang Nguyen On 01/22/2025 at 04:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LYN'S HOME CARE III
FACILITY NUMBER: 374602902

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/22/2025
Section Cited
CCR
80075(k)(5)

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80075 Health Related Services: “(k) The following requirements shall apply to medications which are centrally stored: (5) Each client's medication shall be stored in its originally received container.” This requirement was not met, as evidenced by:
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Licensee agreed to immediately cease the practice of “pre-pouring” medications and storing them in plastic cups, instead only dispensing said pills/tablets from their original labeled pharmacy blister packs at the time that the client is ready to ingest them. Licensee agreed to retrain all staff on this change in procedure, and to submit the training sign-in sheet to LPA, by the POC due date.
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Based on records and interviews, Licensee did not ensure that centrally stored medications for 4 of 4 clients [C1 through Client #4 (C4)] were stored in their originally received container. This posed a potential health risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2025


LIC809 (FAS) - (06/04)
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