Complaint Investigation Report

126801366-10-9-2024-21-AS-VBEI-DA3NEE-20241015102345

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

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

09/09/2024 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20240909084057

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to deliver the results of an investigation into the above allegation. LPA met with Executive Director David Uballez. Based on records reviewed and interviews conducted, LPA found evidence that shows staff gave resident more medication than was prescribed and made errors by removing more medication from the bubble packs than was needed then putting them back into the packs and attempting to seal with tape. Based on records reviewed, there were no misplaced or missing medication due to this however.

Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with David Uballez and Appeal rights were given.