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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
445202597
Report Date:
09/18/2020
Date Signed:
09/18/2020 03:52:33 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
2580 N. FIRST STREET, STE. 350
SAN JOSE
,
CA
95131
FACILITY NAME:
WESTWIND MEMORY CARE
FACILITY NUMBER:
445202597
ADMINISTRATOR:
KAREN TRAVIS
FACILITY TYPE:
740
ADDRESS:
160 JEWELL STREET
TELEPHONE:
(831) 421-9100
CITY:
SANTA CRUZ
STATE:
CA
ZIP CODE:
95060
CAPACITY:
59
CENSUS:
DATE:
09/18/2020
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
Eric Jensen
TIME COMPLETED:
03:00 PM
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Licensing Program Analysts Ryker Heberle and Jackie Jin (LPAs) met with interim executive director Eric Jensen (IED) in order to conduct an unannounced case management tele-visit to review a medical error incident report.
LPAs inquired about the facility's process on monitoring which resident's have received medication. IED clarified that medication is administered and reported one by one in facility database.
LPAs asked what actions were being taken to prevent medication error in the future. IED stated that the med tech would be given additional and thorough training to ensure that they do not make the same error again. LPAs suggested that this training be given to all facility med techs.
LPAs requested copy of action plan for medication procedures.
This report was reviewed with IED Eric Jensen and an electronic copy was provided on 9/18/2020 to obtain a signature.
SUPERVISOR'S NAME:
Sarah Yip
TELEPHONE:
(408) 324-2131
LICENSING EVALUATOR NAME:
Ryker Heberle
TELEPHONE:
714-328-5152
LICENSING EVALUATOR SIGNATURE:
DATE:
09/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/18/2020
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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