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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604426
Report Date: 05/13/2024
Date Signed: 05/13/2024 03:20:14 PM


Document Has Been Signed on 05/13/2024 03:20 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:RIDGEVIEW ASSISTED LIVING COMMUNITYFACILITY NUMBER:
374604426
ADMINISTRATOR:PRABHJOT KAURFACILITY TYPE:
740
ADDRESS:9825 GLEN CENTER DRIVETELEPHONE:
(858) 293-3905
CITY:SAN DIEGOSTATE: CAZIP CODE:
92131
CAPACITY:68CENSUS: 54DATE:
05/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Prabhjot "Mona" KaurTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit.  LPA was greeted by and met with Administrator Mona Kaur, to discuss the purpose of the visit. 

Today's visit is in response to the self reported incident of Resident 1 (R1 - see LIC811 Confidential Names List) who suffered a medication error.

LPA interviewed staff and residents and collected records and a wellness check was completed. 
Deficiencies are cited per California Code of Regulations, Title 22 (refer to the attached LIC809-D).  A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Administrator Mona Kaur, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2024
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 05/13/2024 03:20 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: RIDGEVIEW ASSISTED LIVING COMMUNITY
FACILITY NUMBER: 374604426

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2024
Section Cited
CCR
87465(c)(2)

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(c) If the resident's physician has stated... that the resident is unable to determine his/her own need for nonprescription PRN medication,... facility staff...shall be permitted to assist the resident with self administration, provided...: (2) Once ordered by the physician the medication is given according
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Assisted Living Director (LVN) retrained all Med Techs on medication passes and the 7 rights, and documented the retraining. Counseling was done with S1 regarding the error. Administrator provided the signed training sheets during the facility visit as well as the write-up.
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to the physician's directions.
This requirement was not met, as evidenced by: based on interviews and records, Licensee did not assist 1 of 54 residents (R1) with medication according to the physician's order, which posed a 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: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2024
LIC809 (FAS) - (06/04)
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