Complaint Investigation Report

157209191-12-11-2024-24-AS-SMOA-DC5L24-20241220072140

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

05/21/2024 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20240521121651

Facility staff do not administer resident’s medications as prescribed

On 12/11/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct subsequent complaint investigation on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with Administrator. LPA met with staff Anne Neri and staff Jacqueline tucker. Administrator Sundae Hill was called and arrived shortly. Complaint findings were delivered to Administrator.

During the course of the investigation, residents’ medications were audit and MARs were reviewed,

medications audit showed staff did not administered the residents’ medications as directed by physician.

Based on observation, 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, Chapter 6

are being cited on the attached LIC 9099D. An exit interview was conducted. A copy of this report and appeal

rights were provided to the Administrator, whose signature on this form confirms receipt of this report.