complaint·February 19, 2025

Staff does not ensure resident medications are properly managed Staff does not ensure medications no longer in use are properly discarded Based on documents obtained and statements reviewed for January 2025, the department determined that there was insufficient evidence that any medication errors have occurred. Documents obtained show that all current medications were administered and logged correctly for residents per their doctor’s orders. Five (5) staff interviews indicated that staff were not aware of any medication errors. Five (5) resident interviews expressed no concerns with medication management. Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted. Report left with facility. Licensee is operating the facility beyond its scope of limitations Based on documents obtained and statements reviewed, the department determined that there was insufficient evidence that the facility is operating outside its scope of limitations. Residents are assessed based on change of care, and those that need to be transferred to a skilled facility are transferred if their care needs cannot be met at the facility per RCFE regulations. The facility assists residents that need a higher level of memory care for appropriate placement. Therefore, no regulation has been violated at this time. The above allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Staff does not ensure residents records are properly maintained Based on documents obtained and statements reviewed, the department determined that there was insufficient evidence that facility records were not maintained properly. Department record review found that all records required, in Title 22 87506, were present during record review of resident files. Therefore, no regulation has been violated at this time. The above allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Licensee does not ensure facility has adequate night supervision with a staff on call and within 10 minutes Based on interviews and record reviewed, it was determined that there are 2-3 staff members scheduled to work the NOC shift with at least 2 people on-call within 10 mins away from the facility. The regulations governing night supervision, 87451 (a)(2) states: "In facilities caring for sixteen (16) to one hundred (100) residents at least one employee shall be on duty on the premises, and awake. Another employee shall be on call, and capable of responding within ten minutes." Therefore, no regulation has been violated at this time. The above allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted. Report left with facility.