Complaint Investigation Report

107209035-11-10-2025-24-AS-SMOA-DNLNEC-20251120092342

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

09/04/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20250904143424

On 11/10/25 at 1:00pm Licensing Program Analyst's (LPA) J. Leffall and Licensing Promram Manager (LPM) S. Moua met with fcaility representatives in an office meeting. Findings were delivered on the aboove allegations.

The Department conducted interviews with staff, reviewed facility records, and reviewed resident files. LPA observed Losartan 50MG Take 1 tab by mouth everyday. Start date 9/17/25 and 1 tablet over of punch out date. 10 were punched out and there should have been 9 punched out. Pantoprazole 40mg Take 1 tablet by mouth ever day. Start date 9/12/25 and 1 tablet over of punch out date. 15 were punched out and there should have been 14 punched out. Clopidogrel 75mg take 1 tab by mouth everyday. Per Centrally Stored Medication Record, no start date is labled. Per tablet count start date written on medication bubble pack is 9/19/25. Per date of 9/19/25 there should have been 7 punched out but there were 8 tablets punched out. Asprin 81 mg tab chew. Chew and swallow 1 tablet by mouth every day. Per Centrally Stored Medication Record, no start date is labled. Per tablet count start date written on medication bubble pack is 9/19/25. Per date of 9/19/25 there should have been 7 punched out but there were 8 tablets punched out.

Based on observation, record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Citations were issued on complaint #24-AS-20251020113818.