complaint·October 20, 2025

(Continued from 9099) LPA reviewed the records for R1 and found that the Physician’s Report dated 4/29/2025 states the section for allergies says  “See Attached”.   Staff was unable to find the “attached” list; and staff did not follow up with doctor’s office to verify R1’s allergies, however the pre-appraisal, resident assessment and care plan for R1 all list R1’s allergy to shellfish/shrimp.  A list of residents and their allergies is posted in the med room for care staff to check which includes R1 and their allergy to shrimp. According to the Administrator there is a list in the kitchen with pictures of the residents and their allergies and it is the dietary staff’s responsibility to review the list before serving.  Interviews with R1, Staff (S1)  and  Staff (S2) confirmed that R1 was served shrimp which was not part of their special diet.  Staff S2 reported the resident did not eat the shrimp and staff was able to retrieve the food and bring R1 a meal within R1’s special diet. Based on LPA’s observations, review of records and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation that Staff is not following R1’s special diet is found to be SUBSTANTIATED.  California Code of Regulations, (Title 22, Division 6 & Chapter 8), is being cited on the attached LIC 9099D. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-9099-D, Plan of Corrections and Appeal Rights discussed and provided to Administrator Mark Reyes. Signature on form confirms receipt of documents.