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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001553
Report Date: 01/23/2025
Date Signed: 01/23/2025 12:54:10 PM

Document Has Been Signed on 01/23/2025 12:54 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AN OSPREY RETREATFACILITY NUMBER:
455001553
ADMINISTRATOR/
DIRECTOR:
KNOTT-PUCKETT, GRACEFACILITY TYPE:
740
ADDRESS:2154 OSPREY LNTELEPHONE:
(530) 224-1168
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
01/23/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Administrator, Laurie SchlottmanTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On January 23, 2025 at approximately 12:00 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at An Osprey Retreat for the purpose of conducting a Case Management-Incident Inspection. LPA met with Administrator, Laurie Schlottman and was granted access into the facility.

During the incident, the medication was administered to the wrong resident in care (See LIC 9102-Technical Violation). Staff immediately called the Administrator. Administrator instructed staff to contact Poison Control. Instructions were given by Poison Control. Administrator reported this incident to the Primary Care Physician via facsimile and the Regional Center placement agency. LPA educated the Administrator on the importance of ensuring that ALL medications are dispensed as outlined in the residents physician orders and as outlined in Title 22 Regulations. Administrator reported that staff that dispensed the wrong medication will be going through additional training. LPA also advised that if this medication error happens again, a citation will be issued.

LPA toured the facility and made observations.

No deficiencies were cited during today's Case Management-Incident Inspection. Exit interview was conducted and a copy of this report was signed and given to the Administrator.
Lauren CrockerTELEPHONE: (916) 202-0832
Farhaan SarangiTELEPHONE: (916) 307-0474
DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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