Complaint Investigation Report

157208773-11-22-2021-24-AS-SPIY-C99MVW-20211130085726

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

04/13/2021 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20210413092742

Staff are not following licensed physicians orders as prescribed

An unannounced Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg & Licensing Program Manager (LPM) See Moua. LPA & LPM met with Administrator (Admin) Ramona Eleco & stated purpose of visit.

Resident MARs & Centrally Stored Medication & Destruction Record (CSMDR) reviewed for Resident 1 (R1) & random resident records. MARS not appropriately maintained - no initials that AM medications had been given. CSMDR did not reflect all medications on premises &/or medication was listed on CSMDR & medication not available for review.

The Department has investigated the above allegation & has found it to be Substantiated.