Complaint·January 16, 2025

Allegation: Facility staff did not dispense medications as prescribed. LPA reviewed R1s Medication Administration Record (MAR) and Medication list. LPA noted that the medication list received from the facility is dated from 2021. The MAR for February 2024 indicated that R1 only received their medication Insulin Glargine- YFGN 100 unit/ML SOPN was only given on February 11, 14, 18, 20 and 25, 2024. Per MAR the instruction for the medication is to inject 38 units under the skin daily at bedtime. There are no notes indicating why R1 was not given the medication on the other days throughout the month of February. R1s medication Novolog Flexpen 100 unit/ML SOPN is to be inject three (3) times a day before meals. R1 was not given this medication before lunch February 3, 4, 9, 13, 16, 18 and 22, 2024 as prescribed. The medication was also not given before dinner on February 4, 2024. There are no notes indicating why R1 was not given the medication on these days during those times. Based on LPAs record review, the facility did not ensure that residents were given their medication as prescribed. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations, Title 22 regulations, Division 6, are being cited on the attached LIC 9099D. Allegation: Facility staff left residents home alone without supervision. On 05/30/24 LPA Ratajczak and LPA Hiratsuka arrived at the facility at 7:10AM and met with Administrator Noel Estillore. Administrator stated that the start time for the morning caregiver is 7AM and that Residents start to get up around 8 AM. The facility does have live in staff who is there throughout the night to assist residents with any needs during the nighttime. During time of LPAs visit live in staff was present at the facility but was not working that day. On 09/20/24 LPA Ratajczak conducted a case management visit at the facility. LPA conducted interviews with both staff and residents it was revealed that on the evening of 08/30/24, residents were left at the facility without supervision for about 20 to 30 minutes. Staff hours are from 8 am to 6 pm. Outside of those hours, live in staff is expected to be at the facility. Based on interviews staff left resident at the facility without supervision. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations, Title 22 regulations, Division 6, are being cited on the attached LIC 9099D. Civil penalties are assessed in the amount of $500 for absence of supervision. Allegation: Facility staff did not keep accurate records. During the course of the investigation LPA reviewed Resident #1 (R1) Medication Administration Record (MAR) for February, March, April and May of 2024. LPA observed the MARs for R1 to be incomplete. For the medication Novolog Flexpen 100 unit/ML SOPN, staff did not document on the MAR the site of the injection, blood glucose and the amount given. According to the MARs from February to April, 2024, staff did not fully complete the MAR until April 10, 2024. Based on LPAs records review, the facility did not keep accurate records of the MAR. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations, Title 22 regulations, Division 6, are being cited on the attached LIC 9099D. Exit interview conduct and a copy of the report and appeal rights were left at the facility.