Complaint Investigation Report

197609010-5-13-2025-31-AS-NMAN-DLVVFC-20250926162343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

05/09/2025 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20250509152334

Staff are not following phisician's order

Staff are not documenting the MAR properly

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Yvette Cosme, and advised her of the complaint. According to information received from a direct source, Resident 1's (R1) medication was administered approximately 2.5 hours earlier than the prescribed administration time of 10:00 a.m. A review of the Medication Administration Record (MAR) revealed that the 10:00 a.m. medication had already been signed off and documented as administered, despite the medication not having been given at that time. Additionally, a review of the controlled medication log for on or around May 1, 2025 revealed that medication for Resident 2 (R2) had been pre-signed for all three shifts in the morning, afternoon, and night. Although LPA Cava conducted a record review of medication records for the day, and did not observe any discrepancies or signatures indicating the medicaitons had already been administered, based on the information obtained, and a Correction Action Plan (CAP) that was issued, the above allegations are Substantiated. Citations issued on the 9099D. Administrator advised and a copy of this report issued.