Complaint Investigation Report

486804139-8-25-2023-21-AS-KMOA-CVTLPU-20230919085630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

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

07/10/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20230710111714

Staff did not ensure resident was administered medication.

On 8/25/2023, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Administrator, Elizabeth Hall. LPA toured, interviewed clients, reviewed facility files, medication records and made observations.

Complaint alleges staff did not ensure resident was administered medication. Based on a review of facility records LPA found that on several dates May 6, May 21 and June 28, 2023 the facility had improperly administered medications by administering at the wrong dosage or at the incorrect time based on prescription.

Allegation, staff did not ensure resident was administered medication, is found to be 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 deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Appeal Rights Given