Complaint Investigation Report

236804090-12-27-2024-21-AS-KMOA-DFTU3R-20250417151356

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

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

12/13/2024 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20241213170036

Staff did not administering medication as ordered

At approximately 12:00PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Administrator Isaac Rolle, toured the building and reviewed records. Based on interviews conducted, medication was delivered to the facility and received by a staff member. The medication was placed into the secure storage but the staff did not let anyone else know it had arrived. Resident did not receive the two days of medication due to this mistake. Upon further investigation, the medication was located and resident began receiving as ordered.

Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Administrator and Appeal rights were given.