Complaint Investigation Report

On 11/19/2021, LPA Marrufo interviewed V1. During interview, V1 stated have worked in the facility medication room on an emergency basis when a staff was not available to work in the medication room. V1 stated to have passed medications to residents while unsupervised by a facility staff in the medication room.

On 11/19/2021, LPA Marrufo obtained a copy of May Medication Work Schedule for May 10-20, 2021 The staff schedule had a handwritten note stating that V1 must approve of any changes and a telephone number written below the note. The work schedule states V1 was assigned to work on May 7th and May 8th from 7:00 AM – 3:30 PM.

On 11/19/2021, LPA Marrufo interviewed 6 residents. 3 out of 6 residents stated to have observed V1 working alone in the medication room, and 2 of those 3 residents specified to have observed V1 passing out medications.

Based on records review and interviews with staff and residents, there is preponderance of evidence to prove the alleged violations did occur. Therefore, the allegation is SUBSTANTIATED.

See 9099-D for deficiencies cited per the California Code of Regulations, Title 22.

This report was reviewed with Brian Castenada and a copy of this report and appeal rights were provided.