Complaint Investigation Report

Regarding the allegation: Facility is not following resident's medical orders.

The complainant alleged that the staff is not giving the resident the prescribed routine medication Norco to resident #1(R1). LPA Urena conducted a medication audit together with the staff # 1(S1). To investigate, the LPA reviewed R1’s Medication Administration Log, inspected the Norco medication packets, and the physician’s orders. The LPA found that the medication packets contained the pills inside the bubbles. The LPA found two sets: each set consisted of three packets. Each set had one packet labeled AM, one packet labeled AFTERNOON, and one packet labeled EVENING. One set (three packets) was dated 10/15/2021 and the second set (three packets) dated 10/27/2021. The EVENING packet dated 10/27/2021 had the bubbles numbered # 11, 12, 13, & 14 empty. In addition, the LPA reviewed the medication administration log and found only one entry in the log, dated 10/28/2021-9:00pm. Per the physician's order, the medication Norco is to be administered "by mouth every 8 hours routinely".

Based on the LPA’s observations, interviews, and records reviewed, the above allegation(s) is found to be SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (please refer to LIC 9099-D).

Administrator was on vacation and not available for the exit interview/ Exit interview conducted with Caregiver Mariam Baghgogyan/ Citations were issued/ Appeal Rights Provided / A copy of the repot was emailed to the Administrator for their signature and to be returned signed to the LPA by Monday, November 15, 2021.