Complaint Investigation Report

397003771-12-14-2023-27-AS-LRIS-CYPPFM-20231220101656

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO SOUTH ASC , 9835 GOETHE ROAD, SUITE 100

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

09/20/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20230920111234

Nicole Bacon, Associate Executive Director

Licensing Program Analyst (LPA) Renee Campbell arrived at the facility unannounced on 12/14/23 at 11:30 AM to deliver complaint findings, LPA Renee Campbell met with Associate Executive Director and explained the purpose of the visit.

Allegation #1: Staff mismanage resident’s medication. When interviewed, H1 stated that hospice had to ask the husband to step out so that staff could directly ask R1 if she wanted pain medication. Per H2, R1 asked for pain medication more “towards the end of her decline”. LPA Campbell observed that the Medication Administration Record (MAR) was completed correctly in regard to the doctor’s orders. S1 also explained how staff ensured R1 gave consent for pain management. Based on record reviews and interviews, it is determined that there is not a preponderance of evidence to conclude that the staff mismanaged resident’s medication. Both the doctor’s directives and the clients requests were followed as required.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility.