Complaint Investigation Report

455000113-8-14-2023-59-AS-KHOS-CUSHBU-20230817060343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 9835 GOETHE ROAD, SUITE 100

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

06/06/2023 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20230606112225

Staff are administering residents vitamins without an authorized representative or physician's consent.

On 08/14/23 Donna Gurriere and Jaynae Boyles, Licensing Program Analysts (LPAs) arrived at the facility unannounced to discuss the above mentioned allegation. LPAs met with Lana Carley, Administrator and explained the purpose of the visit.

During the visit, the medications were reviewed for two residents (Resident 1 and Resident 2). It was determined that some of the medications did not have a physician's prescription orders as required.

Resident 1 did not have the following orders, as required for Melatonin, Calcium Magnesum and Probiotics.

Resident 2 did not have the following orders, as required for Acidophilus, Calcium Magnesium and Niacin.

Based on investigation of a medication review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D.