Complaint·June 19, 2025

[Continued from LIC 9099] Interviews with staff and file review corroborate that R1 was given incorrect medications by a staff member (identified as S1), which according to staff interviews, belonged to another resident identified as R2. Interviews with residents did not reveal additional details regarding the incident. Outside source medical records corroborate the timeline of the incident and revealed no changes to R1's medication list post incident. Based on LPA's review and outside source records, along with interviews with staff and residents, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A deficiency was cited per California Code of Regulations, Title 22, Division 6 on the attached 9099D. An exit interview was conducted with Administrator Ancho to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents. [Continued from LIC 9099] Interviews with staff and file review reveal that the facility did follow reporting requirements by submitting an Incident Report to the Department within the required time-frame. Additionally, it was revealed through staff interviews and review of facility records that R1 does not have a designated Responsible Party. Based on interviews and records review, while the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred – therefore the allegations have been determined to be UNSUBSTANTIATED. An exit interview was conducted with Administrator Brooks to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.