Facility Evaluation Report

While at the facility conducting investigation of a complaint (Complaint Control # 15-AS-20260305094639) on this day, March 11, 2026, and upon review of resident's (R1) record, Licensing Program Analyst (LPA) Delmundo observed one of R1's medications which was filled on February 10, 2026 with 84 tablets and administered 3x/day, with start date of administration February 10, 2026, showed this particular medication still has one remaining tablet. Staff (S1) who administers residents medications was not able to explain what happened why there is still one remaining tablet. This was discussed with Haidie Bautista, administrator (ADM), who stated that it could be a recording error.

Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date may result in civil penalty.

Deficiency and plan and proof of correction were discussed with ADM.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.