Complaint Investigation Report

Allegation #1 Staff are not properly trained to administer medications.

Regarding this allegation, it is reported that a staff member was left alone with a client and had to provide medication, however the staff member did not have proper training and a medication error occurred where a client was given the wrong medication. It is further reported that when the incident was mentioned it was simply brushed off. LPA interviewed four (4) out of four (4) clients and it was discovered that they have no knowledge or understanding of being given the wrong medication. LPA interviewed two (2) staff that denied the allegation stating that they have not given incorrect medication to clients, nor have they witnessed any clients to have been given the wrong medication. Both staff present stated that they have received training on how to dispense medication as well as having completed the required hours of shadowing and completed their Direct Support Staff (DSP) training. LPA interviewed the Administrator who denied the allegation, stating that all staff have completed the required initial hours of training in dispensing medication, as well as additional DSP training required by North Los Angeles Regional Center that includes medication training. Additionally, the Administrator showed LPA that initial and ongoing training has all been signed by the employees at the time of completion, as well as monthly ongoing training. LPA reviewed Medication Administration Records (MAR) for all clients and could not locate any errors, any notations of missed medication or notations of medication given in error. LPA reviewed staff records and all staff, including previous staff, have signed and dated their own training, specifically training regarding medication. LPA reviewed DSP training certificates that confirm that staff have completed training required by NLARC. LPA reviewed facility daily notes for the last thirty (30) days and could not locate any documentation of medication errors being notated. LPA reviewed all medication present for the clients, and all medication was accounted for. Based on interviews, observations and record reviews this allegation is deemed unsubstantiated.