Complaint·February 21, 2026

Regarding the allegation medications not given as prescribed, it was alleged that the facility failed to administer medications as prescribed to Resident 1. During the investigation, it was discovered that Resident 1, who was dependent on insulin to manage Type II Diabetes, did not receive her prescribed insulin for approximately one month while residing at the facility. Staff interviews revealed that facility management was aware of the lapse in medication but failed to take action to ensure medication orders were refilled or that appropriate care arrangements were made. The facility Wellness Director stated the resident’s insulin was not being administered due to insurance issues and admitted the facility did not have documentation of a physician’s order for insulin administration. Caregivers confirmed Resident 1’s condition declined over several days, and she became lethargic and weak before being hospitalized. The facility’s failure to maintain accurate medication records, provide the required insulin, and reassess the resident’s medical needs resulted in a severe health decline requiring hospitalization for diabetic ketoacidosis (DKA) and dehydration. Based on record review and interviews with staff, this allegation is substantiated. The following deficiencies are being cited (see LIC 9099D) from the California Code of Regulations, Title 22, and the California Health and Safety Code. This incident is currently under review and a future civil penalty may apply based on H&S Code section 1569.49(f). Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted with Administrator, Rocio Granda (by phone), and Business Manager, Monica Garcia, and appeal rights provided.