Incident investigation·January 12, 2026

Licensing Program Analyst (LPA) Katie Brown conducted a Case Management in conjunction with delivering complaint findings. LPA met with Administrator (AD) Deanne Edwards and discussed the reason for the Case Management. While investigating the complaint Control Number 24-AS-20250910145648 it was reported by the facility that a medication error occurred on 9/3/2025 involving Resident (R1). The facility submitted a Special Incident Report to CCLD on 9/4/25 as required. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D. A Civil Penalty is being assessed on the attached LIC421M for a Repeat Violation An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD.