Complaint Investigation Report

361800187-12-7-2022-18-AS-NBRN-CMJUBH-20221228142618

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SAN BERNARDINO , 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

10/06/2020 and conducted by Evaluator Amber Coleman

COMPLAINT CONTROL NUMBER: 18-AS-20201006151422

Licensing Program Analysts Amber Coleman and Anna Bueno (LPA) arrived at the Rose Valley Facility to make an unannounced visit to initiate a complaint investigation. LPA’s were greeted and invited inside by staff member Delfina Villamore. LPA’s introduced self and stated purpose of the visit.

LPA's conducted staff and resident interviews, records review, and pill count during the visit.

It is alleged that staff are not properly trained and that the medication is being mismanaged. During the records review, LPA reviewed 6 resident Medication Administration Records (MARS) of 6 resident records, 4 records displayed that medications dispensed were not signed for. Dates November 12th through November 23rd were missing signatures. While conducting staff interview regarding missing signatures. S1 explained, "Sometimes they forget to sign, but the medication is given. I will remind them to sign." Pill count for R1 displayed that routine medications were dispensed appropriately.

Review of personnel files revealed training materials were present, however there was no evidence that training was completed by staff members.

We have substantiated the complaint allegation(s) as valid and that a violation has occurred based on the preponderance of available evidence. A copy of this report along with appeal rights are being reviewed with, and furnished to the facility representative. Please see LIC 9099D. A copy of this report along with appeal rights are being reviewed with and furnished to the facility representative.