Complaint Investigation Report

547208833-7-15-2024-24-AS-KHOS-DCNKXA-20250106071714

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

07/10/2024 and conducted by Evaluator Les Xiong

COMPLAINT CONTROL NUMBER: 24-AS-20240710081538

Staff administered one resident's medication to another resident, resulting in hospitalization

Licensing Program Analyst (LPA) L. Xiong conducted the subsequent 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 allegation is SUBSTANTIATED. The incident of staff administering one resident's (R1) medication to another resident (R2), resulting in hospitalizing of R2 did happened. Based on the 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.”)