Complaint Investigation Report

157206770-11-8-2025-24-AS-AWAN-DPHW3M-20251219155611

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

11/04/2025 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20251104132413

Administrator Perla Pena and Welness Care Coordianator Liliana Caftillo

Licensing Program Analysts (LPA)'s Shawna Doucette conducted a visit to commence a complaint investigation. LPA was granted entry by Staff. Staff contacted Administrator Perla Pena and Administrator responded to assist with the visit. LPA met with Administrator and Welness Care Coordianator Liliana Caftillo.

LPA interviewed staff. LPA reviewed records and obtained copies of R1's records.

Based on records review, R1 missed a medication for the month of October 2025 without a doctor order to discontinue or hold the medication. Based on interviews, staff did not contact R1's doctor regarding the missed medication. The preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, deficiencies are being cited on the attached 9099-D.

A copy of this report was provded along with appeal rights and plans of correction.