complaint·December 18, 2024

Regarding the allegation: Facility staff do not dispense medications as prescribed. On 12/11/2024, the Department received a complaint alleging staff not dispensing medications as prescribed. During today’s visit, between 10:36 a.m. and 1:30 p.m., the LPA conducted a review of medication and medication documentation with staff for ten (10) residents and observed the following: Resident #1 (R1’s) Bedtime Senna 8.6 MG tablet had 22 tablets remaining, however the medication was started on 11/28/2024 and with the quantity listed as 60, meaning there should be a total of 20 tablets remaining instead. R1’s Noon Carbidopa-Levodopa 25-100 Tab had 16.5 tablets remaining, however the medication started on 11/28/2024 and with the quantity listed as 45, meaning there should be a total of 15 tablets remaining. Resident #2’s (R2’s) Bedtime Eliquis 2.5 MG tablet had 11 tablets remaining, however the medication was started on 11/28/2024 and with the quantity listed as 30, meaning there should be 10 tablets remaining. R2’s Bedtime Atorvastatin 20 MG Tablet had 9 tablets remaining, however the medication was started on 11/26/2024 and with the quantity listed as 30, meaning there should be 8 tablets remaining. Resident #3’s (R3’s) AM Levothyroxine 50 MCG tablet had 13 tablets remaining, however the medication was started on 12/01/2024 and with the quantity listed as 30, meaning there should be 12 tablets remaining. Resident #4’s (R4’s) Bedtime Donepezil HCL 5 MG tablet had 14 tablets remaining, however the medication was started on 11/30/2024 and with the quantity listed as 30, meaning there should be 12 tablets remaining. Based on observation and record review, the preponderance of evidence standard has been met, therefore the above allegation, “Facility staff do not dispense medications as prescribed” is deemed Substantiated at this time. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency was observed and cited during the visit (See 9099-D). Exit interview conducted. A copy of the report and appeal rights were provided.