Complaint Investigation Report

247200745-7-6-2022-24-AS-SMOA-CHKM4V-20220823091721

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

06/27/2022 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20220627110214

Staff did not distribute medication to residents

Licensing Program Analyst (LPA) K. Kaur arrived at the facility unannounced to conduct an initial 10-day complaint inspection. LPA discussed the purpose of the visit and the elements of the allegations with the Licensee Designee Lucinda Fonseca.

LPA interviewed staff and residents. LPA reviewed records and toured the facility. Based on interviews conducted with the staff, resident’s, and the MARs review; medication was not dispensed to residents.

The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC9099D. Exit interview was conducted and appeal rights