Complaint Investigation Report

286804025-1-9-2025-21-AS-BMOS-DDU28H-20250212161021

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

10/11/2024 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20241011111939

Facility did not re-order medications timely

At approximately 11:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA was met by Caregiver Corina Anguiano. LPA interviewed staff and reviewed records. Based on records reviewed, resident ran out of several medications on several occasions and no refill request was sent until after the medication was gone. This resulted in a family member having to secure an emergency supply until the replacement order was received. LPA issued a citation regarding medication administration on 11/15/2024.

During the course of the this investigation, LPA requested staff training records. Licensee was not able to provide documentation of completed staff training to meet the number of hours required by regulation.

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 Corina Anguiano and Appeal rights were given.