Complaint Investigation Report

547208809-9-1-2023-24-AS-SMOA-CVVLU5-20230921090322

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

06/26/2023 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20230626083044

Executive Director/ Administrator Mandy Rancour

Licensee does not ensure there is an Administrator or designated substitute present at all times

Staff failed to administer resident's medication as prescribed

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit and reviewed records. LPA met with Administrator Mandy Rancour and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. Based on observations, interviews and record review a designated substitute was not present at all times while Administrator was on leave. LPA reviewed Residents (R1) medication records and observed medication that was logged in the Centrally stored medication and destruction record (CSMDR) was not sufficient to meet the administration of medication as directed by the physician.

The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC9099D. Exit interview was conducted with Administrator and appeal rights were provided.