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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801730
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:47:52 PM

Document Has Been Signed on 08/31/2022 02:47 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:FINEST LIVING AT ARCADEFACILITY NUMBER:
565801730
ADMINISTRATOR:GARNER J. CRUZFACILITY TYPE:
740
ADDRESS:350 SOUTH ARCADE DRIVETELEPHONE:
(805) 628-9181
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 6CENSUS: 4DATE:
08/31/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Marlene SantosTIME COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Case Management - Deficiencies inspection due to deficiencies observed during the 08/31/2022 complaint investigation inspection.

The LPA observed the following:

During file review for Resident #1 (R1), R1 did not have in file a record of centrally stored prescription medications. Also, the Medication Administration Record (MAR) staff use to document when a medication is given did not list Haldol 2mg for the months of June and July although there was an order in file for the medication dated 05/05/2022, and the medication was listed on the MAR for May and June.

At 12:35 PM, the LPA also observed current medications for Resident #2 (R2) and Resident #3 (R3) were not listed on the record of centrally stored prescription medications, including medications dispensed by the pharmacy on 08/03/2022 and 06/21/2022 for R2 and medications dispensed by the pharmacy on 08/25/2022, 07/18/2022, 06/30/2022, and 05/27/2022 fo R3.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted with caregiver Marlene Santos. Reports and appeal rights were reviewed and emailed to the Administrator.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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Document Has Been Signed on 08/31/2022 02:47 PM - It Cannot Be Edited


Created By: Kasandra Lopez On 08/31/2022 at 01:16 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
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FINEST LIVING AT ARCADE
FACILITY NUMBER: 565801730

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/07/2022
Section Cited
CCR
87506(a)

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87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This requirement is not met as evidence by:
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The administrator shall submit proof staff have received training regarding keeping complete and current records for the residents. Proof of training shall be completed and submitted to the LPA by 09/07/2022.
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Based on observation, the licensee failed to comply with the section cited above as one resident (R1) did not have their medication administration record complete with all medications they are receiving which poses a potential health and safety risk to residents in care.
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Type B
09/07/2022
Section Cited
CCR87465(6)(A)-(F)

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87465 Incidental Medical and Dental Care (6)(A)-(F) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident ..(B)..prescribing physician.....This requirement is not met as evidenced by:
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The administrator shall submit proof that R2 and R3 have an up to date record of centrally stored medications and staff receive training in regards to regulation 87465. Proof of updated records and training shall be completed and submitted to the LPA by 09/07/2022. (Note: R1 is no longer a resident at the home, therefore updated records are not needed.)
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Based on observation, the licensee did not comply with the section cited above as R1 did not have record of centrally stored medications and R2 and R3 did not have their current medications listed on the centrally stored records which poses a potential health and safety risk to residents 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:Desaree Perera
LICENSING EVALUATOR NAME:Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022


LIC809 (FAS) - (06/04)
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