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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602980
Report Date: 07/11/2023
Date Signed: 07/11/2023 04:47:53 PM

Document Has Been Signed on 07/11/2023 04:47 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:RUCKER FACILITYFACILITY NUMBER:
374602980
ADMINISTRATOR:LINDA RUCKERFACILITY TYPE:
735
ADDRESS:13662 POWERS RDTELEPHONE:
(619) 857-7144
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 5DATE:
07/11/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Linda Rucker, LicenseeTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Esther Miller cited deficiencies discovered during an unrelated complaint
visit. LPA was granted entry after identifying herself by Linda Rucker, Licensee, with whom she discussed the purpose of the visit.

During today's visit, LPA observed prepoured medication on a shelf in the kitchen. Licensee explained that volunteer Valma Nigro, who has medication training, came to the facility every two days to prepour client's medication into small, clear, plastic containers. Volunteer signed each cup with her initials after prepouring the medication. Volunteer would leave the medication and containers in a locked room at the back of the facility. Staff would retrieve the medication around the time it was prescribed to be given. During today's visit, LPA observed staff leave the medication on a shelf until it was time for client to take the medication. Shelf was about five feet off the ground and readily accessible to clients.

Once medication was given, staff and Licensee stated that staff would sign the Medication Administration Record. Licensee stated that medication was given this way to ensure that clients did not miss any doses due to caregiver error. Licensee stated she was given permission by San Diego Regional Center in 2007 to prepour medication up to two days in advance.

Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached
LIC809D and a plan of correction was developed. An exit interview was conducted with Licensee and
a copy of this report, along with Licensee/Appeal Rights (LIC9058 03/22), were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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Document Has Been Signed on 07/11/2023 04:47 PM - It Cannot Be Edited


Created By: Esther Miller On 07/11/2023 at 02:26 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: RUCKER FACILITY
FACILITY NUMBER: 374602980

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
80075(k)(5)(6)

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80075 HEALTH RELATED SERVICES:(k) ... requirements shall apply to medications: (5) ...medication shall be stored in its originally received container. (6) No medications shall be transferred between containers. This requirement is not met as evidenced by:
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Licensee will provide proof of medication training of each staff member from an outside vendor. Licensee will also stop medications from being prepoured.
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Based on interview and observation, the licensee did not ensure complete records were maintained in 5 of 5 persons in care which poses 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:Denise Powell
LICENSING EVALUATOR NAME:Esther Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023


LIC809 (FAS) - (06/04)
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