Complaint Investigation Report

157209319-10-23-2023-24-AS-SPIY-CX8URD-20231103154834

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

09/25/2023 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20230925092844

Staff did not ensure that resident was administered their medication(s) in a timely manner.

Licensing Program Analyst (LPA) Shawna Doucette conducted a visit to commence a complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Katie Blair.

LPA reviewed records and interviewed staff. During records review it was found C1's PRN was instructed to be given as needed every 6 hours. After reviewing MARS log C1 was given the medication before the 6 hours on 09/20/23, 09/27/23 and 09/28/23.

Based on record review and interviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

An exit interview was conducted with Administrator Katie Blair and a copy of this report along with appeal rights and plan of correction were provided.