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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570317743
Report Date: 07/14/2022
Date Signed: 07/14/2022 10:29:33 AM

Document Has Been Signed on 07/14/2022 10:29 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:DAVIS SUMMER HOUSEFACILITY NUMBER:
570317743
ADMINISTRATOR:JULIE HUNTERFACILITY TYPE:
735
ADDRESS:2525 EAST 8TH STREETTELEPHONE:
(530) 757-1294
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 14CENSUS: DATE:
07/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Julie Hunter, AdministratorTIME COMPLETED:
10:30 AM
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LIcensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to investigate an Incident Report regarding a med error which involved a medication refill for a client. LPA interviewed Administrator, JN and learned that getting timely refills from Doctors' offices is becoming problematic, due to staffing shortages across the board. Although the facility began the refill process within the timeframe specified by the substance being requested, the offices of both the PCP, neurologist, pharmacy and other entities were unable to provide a refill of the medication. Finally, the pharmacy could refill a variation of the medication, which required a new prescription. Supply of exact same medicatons as specified by the doctors is part of the concern. This particular case required the medication to be switched from (1) 200mg. tablet to (2) 100mg. tablets. That required a new prescription, once again.

LPA is aware that the Administrator is working diligently with all parties to see that this is not an ongoing concern. Administrator has suggested possible switch in doctors, however part of the issue for some clients is insurance/choice of doctors/change in services. Again, Administrator is well aware of the challenges going forward, and facility team is working hard to provide a continuum of care.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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