Complaint Investigation Report
conducted a record review of R1's medications and medication records. R1's medications are bubble pack. Review of R1's PRN Medication Log reveal that these medications were administered on 10/07/25 and 10/08/25 for agitation and yelling. Between 10:45am to 12:00pm, LPA interviewed four (4) of four residents. Interviews with these residents do not corroborate with the allegation. Moreover, during the ten day visit, LPA spoke with R1's family, who was at the facility at that time. R1's family raised no concerns regarding care and supervision, or of staff over medicating R1.
Based on the information obtained, there wasn't enough evidence to prove that staff are over medicating R1. Therefore, the allegation is deemed Unsubstantiated at this time.
Staff are not meeting resident's diaper needs:
In regards to the allegation, it's being reported that on or around 10/06/25, R1 was observed to have dried gauze and stool on the buttock area. No witnesses were identified to corroborate this allegation. R1 is confirmed to be receiving hospice care by the reporting party. Between 8:45am and 9:45am, interviews with administrator and one (1) of one staff confirm that R1 is receiving hospice care, and as part of R1's hospice care plan, there is treatment for a Stage II Pressure Injury (PI) to R1's buttock. Administrator stated hospice nurse comes to check and treat R1's PI two to three times per week. Part of the treatment is to apply the gauze to R1's PI. Both administrator and staff deny ever leaving R1 with dried gauze or stool as they come into communication with hospice during the nurse's visits. Between 9:45am and 10:45am, LPA conducted a record review of R1's hospice care plan to confirm service. Between 10:45am to 12:00pm, LPA conducted interviews with four of four residents. These residents expressed no concerns regarding care and supervision and had no complaints of their needs not being met.
Based on the information, there was insufficient evidence that staff are not meeting resident's diaper needs. Therefore, the allegation is deemed Unsubstantiated at this time.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction