Facility Evaluation Report

This unannounced Case Management – Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 22-AS-20250402163711. LPA met with Administrator (AD) Faith Rassouli and explained the reason for today’s inspection.

During the course of the investigation, LPA inspected the facility, interviewed AD, residents, staff, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Medication List.

LPA interviewed AD who stated that R1’s prescription for Atorvastatin changed from 20MG to 10MG, the facility received both doses in November 2024 and January 2025, the facility did not notify the doctor, pharmacy, or R1’s family of the issue, and AD discarded the 20MG dose after it was replaced by the 10MG dose without keeping a medication destruction record. One witness interviewed stated that they learned that R1 had two doses of the same medication by observing it themselves and that they addressed the issue with R1’s doctor and pharmacy because the facility had not. LPA reviewed R1’s Medication List which shows that R1 received both doses of Atorvastatin in November 2024 and again in January 2025, which shows that the facility did not properly address the medication issue in November 2024 because both doses were received again January 2025.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.