Complaint Investigation Report

107209035-8-14-2025-24-AS-SMOA-DKKTAS-20250815143400

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

08/07/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20250807125000

Staff utilized bed rails for residents without a written order from a physician

Staff are not properly safeguarding medications

On 8/14/25 at 10:00 am Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit and to deliver findings on above allegations. LPA met with General Manager (GM) Michelle Ramos and stated purpose of visit.

The Department reviewed records and conducted interviews with residents and facility GM.

Based on the records review and interviews that were conducted with residents and GM, LPA toured 6 resident rooms and 1 of them contain bed rails. Resident rooms that were toured include rooms 119, 126, 137, 138, 204 and 205. GM provided a written order prescribed by the Dr. confirming that R1 in room 137 may contain bed rails for resident safety.

Based on the records review and interviews that were conducted with residents and GM, LPA toured 6 resident rooms. Toured rooms include 119, 126, 137, 138, 204 and 205. 2 of the resident's rooms contained medications that were accessible to resident's. LPA requested the LIC-602 to R2 and R3's room and both LIC-602 forms confirmed that R2 (Room 138) and R3 (Room 250) are capable and competent to self-administer medications.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued.

Exit interview conducted. A copy of this report was distributed to General Manager which confirms signature of report.