complaint·February 3, 2026

LPA Urena interviewed staff and residents from approximately 10:30 a.m. to 12:26 p.m. and requested records pertinent to the investigation. At 2:35 p.m. the Licensee arrived at the facility, and the LPA interviewed the Licensee at approximately 2:40 p.m. Staff did not administer medication to a resident in care. On the allegation that staff did not administer medication to a resident in care, it is the concern of the reporting party that the resident (R1) is not receiving their medication as prescribed. The LPA was unable to communicate with the RP for further information. To investigate the allegation at approximately 1:22 p.m. the LPA conducted a medication audit and interviewed residents. One resident stated they get their medication on time, one resident stated that they do not take medications. The medication audit consisted of reviewing the LIC 622 (Centrally Stored Medication and Destruction Record) and auditing prescription bottles/counting pills. The record review of the LIC 622 for R1 revealed that medications are not being recorded as they are received by the facility and discrepancies were found on dates (filled/ start date/ expiration date) between the LIC 622 and the medication bottles. One medication bottle for Atorvastatin (40mg./100 pills, 1Xd) with a count of 21 pills left in the bottle, showed that the medication bottle was filled on 08/21/2025 per the prescription label, however the LIC 622 stated the medication was filled on 03/27/2025. At the time of the medication audit the medication should have been refilled. It is unknown when the first day of the medication was given as the dates on the LIC 622 could not be confirmed. The second medication audited was Hydralazine (25m./90 pills/3xd) which was not registered in LIC 622. The interview with staff revealed that they assist two residents with insulin injections, furthermore, staff stated that they do give the medications to the other residents as prescribed. However, due to the medications not being properly documented in the LIC 622, it’s impossible to assess if residents have been properly assisted with their prescribed medications. The Licensee’s interview revealed that they could not explain the medication discrepancies. Based on observation of the medication audit, and the interviews, the Staff did not administer medication to a resident in care as prescribed. Therefore, the allegation is deemed Substantiated at this time. Continues on LIC 9099C... page 3. Staff did not keep facility free of vermin. On the allegation that the facility is not kept free of vermin, it is the concern of the RP that the facility has cockroaches and mice. To investigate the allegation, the LPA conducted interviews and inspected the facility grounds. Based on the interview of residents, residents stated that they have seen mice and cockroaches in the kitchen area, but not in their rooms or other areas of the facility. At approximately 12:05 p.m. the LPA inspected the kitchen area and observed cockroaches in the pantry area, while inspecting the dry food items and fruits. The LPA did not observe mice at this time. Based on interviews and observation, the facility is not free of vermin. Therefore, the allegation is deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 9099-D). Exit interview was conducted. A copy of the report and Appeal Rights were provided. LPA Urena interviewed staff and residents from approximately 10:30 a.m. to 12:26 p.m. and requested records pertinent to the investigation. At 2:35 p.m. the Licensee arrived at the facility, and the LPA interviewed the Licensee at approximately 2:40 p.m. Staff did not ensure that the residents room is free of clutter and trash. Onn the allegation that staff did not ensure that the residents’ room is free of clutter, trash and kept clean, it is the concern of the RP that the residents rooms and bathroom trash cans are overflowing with trash, and the rooms are full of dust. To investigate the allegation, at approximately 10:35 a.m., the LPA conducted a tour of the facility, and observed the residents’ rooms to be clean, and trashcans empty. However, two bedrooms appeared to have lots of personal items that appear to give the room an appearance of clutter. No dust was observed, and residents stated that staff do clean the rooms frequently, at least one a day. Although the allegation may have happened or is valid, based on the interviews, and observation, there is not sufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Exit interview was conducted. A copy of the report was issued.