Complaint Investigation Report

During visit conducted on 1/07/2025, LPA attempted to conduct a medication count. LPA observed that the facility is not documenting start dates to indicate when resident medications are started. LPA observed that they were unable to conduct a medication count of the residents' medications due to having insufficient information regarding medications. LPA also observed medications on cite for resident (R1) that did not have a doctor's order on file at the facility.

During visit conducted on 1/15/2025, LPA conducted a medication count for R1 using information documented at the facility. LPA observed inconsistencies between medications counted and what was documented at the facility. LPA observed medications and doctor's orders on cite for residents R1, R2, and R3 at the facility. LPA observed doctor's orders for medications for R1, R2, and R3 that were not on cite. LPA observed medications for R1 and R2 on cite that did not have doctor's order on file.

During visit conducted on 1/07/2025, LPA observed the entryway in R1's bedroom contained a plastic mat. LPA felt underneath the mat and observed that carpet underneath the plastic mat was damp. LPA observed soiled pee pads in the cabinets underneath the kitchen sink. During visit conducted on 1/15/2025, LPA observed plastic mat removed from R1's bedroom entryway. LPA felt carpet where plastic mat was and observed that carpet in R1's bedroom was still damp. LPA observed underneath kitchen sink and observed soiled pee pads to be damp.

Based on medication review, LPA's observations, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. A civil penalty in the amount of $250 was assessed for today's date due to a repeat violation.

Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.