Complaint Investigation Report

547209213-2-12-2025-24-AS-AWAN-DEETQM-20250303135607

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

08/15/2024 and conducted by Evaluator Les Xiong

COMPLAINT CONTROL NUMBER: 24-AS-20240815134326

Staff are not properly documenting residents medications

Staff mismanaged residents’ medications (med errors happening with multiple residents)

Licensing Program Analyst (LPA) L. Xiong conducted a complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff on duty and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegations are SUBSTANTIATED. LPA observed from the investigation that the facility fail to properly documenting residents' medications and mismanaged residents' medications thus leading to medication errors for residents R1 and R2. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”)