complaint·November 9, 2021

Continued LIC9099-C page #2 Allegation #2: Resident not administered medication as prescribed. Staff and residents interviewed stated residents receive their medications at the facility as prescribed daily. LPA conducted a file review of the Facilities Digital Medication Administration (MARS). The documented Mars showed that R1 received Simbrinza 1%-0.2%, instill one (1) drop in the right eye twice a day, and Systane Complete 0.6% instill one (1) drop in each eye twice daily and was initialed by administering Med Tech of the hours. Staff stated once ordered by the resident's physician the medication is given according to the physician's directions. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. A copy of the Complaint Investigation Report LIC 9099-A, LIC 9099-C, and Confidential Names LIC 811 was provided to Administrator Terri Weitzman There were no deficiencies cited. Exit interview conducted Continued LIC9099-C page #2 Allegation #1: Staff not keeping resident room free from pests. Staff 1-5 (S1-5) and residents 2-9 (R2-9) interviewed stated if they notice any pest staff will contact an exterminator immediately. R2-9 stated they are happy here, the staff goes out of their way to provide excellent care to them, and they have not observed any pests in their rooms or throughout the facility. Staff stated they self-reported the incident regarding roaches in three of the rooms, and flies in the kitchen, dining room, and one bathroom near the kitchen prior to the complaint. Staff stated AMEN Pest Control comes to the facility monthly and sometimes twice a month to prevent the incident from occurring. Staff agrees AMEN Pest Control invoice dated 11/03/2021 indicated initial roach cleanout for units 157, 257, 159. However, there were no roaches mentioned in R1’s unit 158. On 08/05/2021, 09/02/2021, and 10/07/2021, there were flies in the kitchen, dining room, and one bathroom that’s by the kitchen was treated for flies. During today’s visit, we did not observe any cockroaches or cockroach feces in R1’s unit. There were no cockroaches in the fridge, bathroom, dresser, TV, and dishes. We did not observe any roaches or flies in the facility. Based on LPA’s observations, interviews that were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D. Appeal rights were discussed, and copies of LIC9099, LIC9099-C, and LIC9099-D was provided to the Executive Director (ED) Terri Weitzman. Exit interview conducted.