Complaint Investigation Report

079200825-4-4-2023-15-AS-KHOS-CRLPJZ-20230507112221

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1515 CLAY STREET, STE. 310

This is an official report of an unannounced visit/investigation of a complaint received in our office on

03/28/2023 and conducted by Evaluator Carol Fowler

COMPLAINT CONTROL NUMBER: 15-AS-20230328172856

Facility not properly storing medications.

On 4/04/2023 at 9:45AM, Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Administrator Yanlin "Cynthia" Huang and explained the purpose of the visit.

During the complaint investigation, LPA conducted a tour of the medication closet and interview with S1. LPA observed 3 to 5 days of pre-poured medication transferred into a weekly pill organizer for all 5 residents. S1 stated that S1 pre-poured /transfered the medication in the weekly pill organizer for all 5 residents.

Based on LPAs observations and interview, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.