Complaint Investigation Report

157209320-8-5-2023-24-AS-SPIY-CUXMHW-20230822093814

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

08/01/2023 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20230801114417

Staff did not administer medication to resident.

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 Steven Cruz.

LPA reviewed records and interviewed staff. Staff did not have a start date for medication and verbally stated C1's medication started on 08/2/23. C1's medication shows given already for today and was not supposed to be administered until bedtime. LPA took photos of medication.

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 Steven Cruz and a copy of this report along with appeal rights and plan of correction were provided.