Complaint Investigation Report
On June 20, 2024, LPA Simi Rai interviewed staff S1. S1 stated he/she does not recall if a resident consumed medications that were left on the table. S1 stated in Memory Care unit the protocol is to ensure the resident takes the medication and wait with them until they swallow the medication. S1 stated the med-tech doesn’t leave the medication lying around because the resident may forget to take the medication.
On September 30, 2025, LPA Manuel Monter interviewed residents R3-R7. 5 Out of 5 residents (R3-R7) stated they handle their own medications, doesn’t need staff assistance and hasn’t had any issues with his/her medications.
LPA Monter interviewed Staff S1-S3, S5. LPA also interviewed S4 & Current Memory Care Director, Norlynn Peterson. Staff S1-S3 & S5 stated staff gives residents their medications in person. Staff S1-S3,S5 stated medications are not given when residents are dinning. 5 Out of 5 staff (S1-S5) stated they haven’t seen or heard about residents taking each others medications.
On October 6, 2025, LPA Manuel Monter interviewed Witness W1. W1 stated he/she doesn’t remember when the incident where R1 took R2’s medication occurred. W1 stated he/she was contacted by an unknown staff who informed him/her about this incident.
On November 20, 2025, LPA Monter interviewed residents R2, R8-R11. 2 Out of 5 residents(R8, R9) interviewed stated they have not had any issues with receiving their medication. 2 Out of 5 residents(R8, R9) interviewed stated there hasn't been a time when they observed a resident taking other residents medication. 3 Out of 5 residents (R2, R10, R11) interviewed were unable to provide any relevant information due to neruocgonetive disorder.
LPA interviewed staff S6-S9. 4 Out of 4 staff (S6-S9) stated medications are administered to residents in person, and the medtech will watch them take the medication before leaving. 4 Out of 4 staff (S6-S9) stated they haven't seen or heard about any instance of a resident taking another residents medication and consuming it.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction