Follow-up·November 4, 2021

Licensing Program Analysts (LPAs) Marybeth Donovan and Christine Delores conducted an unannounced case management visit to discuss record keeping of centrally stored medications. LPA met with Biao Zhang Administrator. During a medication audit on 08/28/2020 for an investigation and based on interview with Administrator that the centrally stored medication record start dates were not accurate. The start dates did not reflect the actual start date for medications with multiple refill bottles. When the resident is done with one bottle, the Administrator will start a new bottle. Also, the Administrator would mix medications from the existing bottle with the new prescription bottle. The actual start date was not recorded. LPAs reviewed medication procedures and record keeping of centrally stored medications with Administrator. The Administrator stated that prescription medications bottles are not mixed and accurate medication start dates are reflected on the Centrally Stored Medication Record and each prescription bottle. The following Advisory Note was issued see attached LIC9102 per the California Code of Regulations, Title 22. This report was reviewed with Biao Zhang Administrator and a copy provided.