Complaint Investigation Report

392700123-11-5-2021-27-AS-LKIG-C8ZR3W-20211122114038

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 2525 NATOMAS PARK DR. STE.270

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

09/27/2021 and conducted by Evaluator Bruce Jacobs

COMPLAINT CONTROL NUMBER: 27-AS-20210927160134

Facility did not dispense medication as prescribed

Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Facility Administrator Gina Hernandez to deliver investigation findings on the above allegation. This investigation consisted of site inspections to the facility to conduct interviews with the facility administrator, staff and residents. LPA reviewed and obtained copies of the resident's files.

This investigation concluded that a resident (C-1) was not properly assisted with his medications. The resident had orders for three medications from 1/18/2019. Facility records did not document these medications being ordered, discontinued or administered as required.

As a result of this investigation, LPA finds the allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiency is cited on 9099-D, per Title 22 Regulations, Division 6.

Exit interview conducted and report provided. Appeals rights printed