Complaint Investigation Report

157209146-9-10-2024-24-AS-SPIY-D9UKXX-20241008081815

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

06/27/2024 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20240627092941

Licensing Program Analyst (LPA) Shawna Doucette (LPA) conducted a visit to commence a complaint investigation. LPA discussed the purpose of the visit and the elements of the allegations with Administrator Nancy Cudal.

LPA reviewed records and interviewed staff and residents.

Based on records review and interviews, there is missing documentation for pain medication (PRN) being administered for R1. R1's June 2024 MARS log shows Olanzapine twice but does not show why one of the medications was not being administered. It is unknown if the medication was discontinued due to lack of documentation or missed for June 2024.

Based on the Departments interviews and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. Civil Penalty issued for repeat violation.