Incident investigation·March 7, 2022

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on an incident report submitted to Community Care Licensing on 02/03/2022. LPA was allowed entry into the facility and met with Executive Director Melinda Forney. Incident report dated 02/01/2022 indicated Resident 1's (R1) discontinued Lorazapam 0.5 was discovered to be empty. Per medication records there should have been 30 pills left. Medication was being stored in an area waiting for destruction. Facility looked for the medication and called Irvine Police Department who came out and took a report. Facility interviewed staff as well as a registry nurse who had been working at the facility. All interviewed denied any knowledge of the missing medication. Facility contacted registry and advised staff would no longer be working at the facility. Facility has changed their procedure for medications waiting for destruction and Nurse Manager is auditing the medications for error. Cash value of medication is $19.00. No further investigation needed. Exit interview conducted and a copy of this report was left at the facility.