Complaint Investigation Report

157206770-6-20-2025-24-AS-SMOA-DHXKA2-20250624074309

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

04/03/2025 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20250403143730

Staff do not distribute resident's medications as prescribed

Staff did not ensure that resident takes medication as prescribed

On 06/19/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct subsequent complaint investigation and delivered complaint findings. LPA introduced self, stated the purpose of the visit, and met with Administrator Perla Pena.

During the course of the investigation, the department conducted interviews, reviewed records, and toured the facility. R1 have doctor’s order for medications to be crush and to be in applesauce and yogurt. Records and interviews confirm R1 refuses medications. Based on observation and interviews conducted, the preponderance of evidence standard has not been met, therefore, the above allegation are found to be UNSUBTANTIATED. An exit interview was conducted. A copy of this report was provided to the Administrator, whose signature on this form confirms receipt of this report.