Complaint Investigation Report

415600729-3-25-2026-14-AS-BCHN-DVL3A9-20260701180422

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SAN BRUNO RO , 851 TRAEGER AVE., SUITE 360

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

02/04/2026 and conducted by Evaluator Jaime Vado

COMPLAINT CONTROL NUMBER: 14-AS-20260204105434

- Staff are not documenting medication properly

On 03/25/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint inspection visit to deliver findings regarding the allegations received. LPA met with Olivia Deanda and explained the purpose of today's visit.

During the investation, LPA interviewed staff and reviewed pertinent documents. LPA reveiwed facility's centralized medication record and daily record for medications. Per review, LPA observed that the medications are logged correctly in the centralized medication record for prescribed medications, but for the daily record for medications, LPA did observe prefilling of medications being administered to a resident for a few days, which supports the information received as part of the complaint. It was indicated in the complaint supporting documents that medications were marked as from 1/13/26 to 1/20/26 before they were actually given and this record was observed by the complaining party on 1/14/26. LPA observed this record and confirmed observation and the reporting of this. Based on this observation, LPA confirmed that PRN medication is not accurately documented on the MAR for R1. This allegation is substantiated.

Based on LPA interviews and items received, 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, are being cited on the attached LIC9099D. Report is reviewed with administrator. A copy of report is provided with appeal rights.