Complaint Investigation Report

336424105-2-23-2022-18-AS-EMAN-CHLUKN-20220824153925

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1650 SPRUCE ST STE 200 MS29-27

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

09/16/2020 and conducted by Evaluator Jennifer Semin

COMPLAINT CONTROL NUMBER: 18-AS-20200916081046

Facility staff mismanaged resident's medications while in care

Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to deliver the findings for the above complaint allegation. LPA met with Resident Relations Director, Edgar Gallardo.

The investigation consisted of interviews and review of records. The allegation, Facility staff mismanaged resident's medications while in care. Staff and Resident 1 (R1) stated staff give R1 their medication on time and in correct amount. The Medication Administration Record (MAR) indicates that the medication was not given according to R1's physician’s order and that R1 had refused or refused to take the full dose prescribed on multiple occassions.

Based on interviews and documentation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 1) is being cited on the attached LIC9099D.

An exit interview was conducted where this report, LIC9099D, and appeal rights were discussed and provided to Mr. Gallardo.