Complaint Investigation Report

The investigation revealed of the following: Allegation#1 "Staff mismanaged clients' medications" LPA reviewed all four clients medication in the facility and observed C2's PRN medication Lorazepam 0,5mg was not indicated on the MARs.

LPA observed the staff had been documented the date and time that C2 took the medicine on the back of MARs. It documented 10 times on the MARs but on the bubble pack medication, 11 days of medication was taken out (dated June 1st to 11th) and LPA asked staff and they were not able to explain the reason.

Allegation#2 "Facility failed to meet reporting requirements in a timely manner." LPA reviewed the CCL internal incident reports and unusual incident reports that submitted by the facility and LPA did not observe the facility sent any incident report on 4/11/2023 about C3's AM medication was not dispensed, and staff initiated on the MARs.

Allegation#3 "Facility failed to comply with the requirements for back up Administrator." LPA spoke to the staff and the back up administrator and reported the administrator on file had been out from the facility for couple weeks and they admitted they never reported to CCL for the changes of the facility and who is responsible to carry out the administrator responsibilities during administrator absence and never sent any supported documents to CCL until June 26th, 2023 via mail. LPA also never received any LIC308 (Destination of Facility Responsibility) prior today's visit.

Based on the record reviewed, and interviewed conducted with staff, the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit Interview conducted and copy of the report and appeal right were provided to the backup administrator Zonel Pascasio