Facility Evaluation Report

While at the facility conducting investigation of a complaint (Control # 15-AS-20250914203842) and upon review of residents' (R1 and R2) files and interview, Licensing Program Analyst (LPA) Delmundo learned that resident (R1) was not given 1 of the prescribed medications from 9/01/25 to 9/08/25 and 1 other medications from 9/01/25 to 9/18/25 due to medications not available. The staff stated that the medications were not refilled. The staff also stated that the other resident (R2) should not be given 1 of the medications per Pain Management Clinic when this resident is administered pain medication; however, there's no order on R2's file indicating such.

Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. A $250.00 civil penalty is assessed for repeat violation within 12 month period of section 87465(a)(4). Failure to submit proof of corrections by plan of correction due date may result in additional civil penalty.

Deficiency, plan and proof of correction and civil penalty were discussed with David Clawson, administrator.

Exit interview conducted. Appeal Rights, LIC421FC Civil penalty assessment, LIC9098 Proof of Correction form and copy of this report provided.