Complaint Investigation Report

157206770-3-11-2022-24-AS-SPIY-CCRL78-20220322082956

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

02/14/2022 and conducted by Evaluator Les Xiong

COMPLAINT CONTROL NUMBER: 24-AS-20220214154055

Resident's medication is being mismanaged.

Licensing Program Analyst (LPA) L. Xiong conducted the subsequent complaint investigation visit to the facility. LPA met with staff Dawn Dewees and spoke to Administrator, Benny Farillas over the phone and informed him the purpose of the visit.

During the course of this complaint investigation, LPA interviewed staff and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegations are SUBSTANTIATED. Facility did mismanaged resident R1’s medication. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”)