Incident investigation·November 7, 2022

Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced case management visit due to an incident that was reported to licensing. LPA met with Health Service Director and explained the reason for the visit. LPA conducted a physical plant walk through, at approximately 11:00am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA conducted interview with the Health Service Director, two (2) out of two (2) MedTechs and reviewed Resident #1 (R1's) facility records from 11:45am to 2:00pm. LPA also obtained copies of pertinent documents relevant to the investigation. Upon review of documents LPA observed the following: R1's Medications were not documented on Centrally Stored Medication and Destruction Records (CSMDR) At the time a civil penalty of $1,000.00. was issued (repeated violation) and a citation was recorded on LIC809D. LPA also has determined further investigation is needed and will return at a later date to continue the investigation. Exit interview conducted. Appeal rights explained. Copy of this report signed and delivered.