Facility Evaluation Report

While at the facility conducting an investigation of a complaint (Control # 15-AS-20250204131826) and upon review of resident's (R1) file, LPA observed R1's medications on the medication bottles were discarded to a container. R1 was discharged from the facility effective 1/29/25. The Medication Destruction page of the LIC622 Centrally Stored Medication and Destruction Record was not completed.

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 civil penalty.

Deficiency and plan and proof of correction were discussed with Lulin 'Lucy' Wu, back-up administrator.

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