complaint·April 4, 2025

Page 2 LPA conducted inspection on 10/14/21 and interviewed staff on 12/06/24 and 4/04/25. All three housekeepers interviewed stated that during peak of Covid-19 on 2020 and 2021, there were only about 3, 4, 5 housekeepers. Two out of this 3 housekeepers stated they were not able to clean all the residents' rooms. One of these 2 housekeepers stated that this housekeeper was also assigned to do the laundry. Therefore, the allegation is substantiated. A finding that a complaint is substantiated means that the allegation is valid because the preponderance of evidence standard is met. Deficiency is cited from Title 22 California Code of Regulations and listed on 9099D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with the ED over the phone. ED authorized Ernesto Buendia to sign and receive this report. Exit interview conducted. Appeal Right, LIC9098 Proof of Correction form and copy of this report provided. Page 2 Allegation: Resident (R1) was severely dehydrated. - UNSUBSTANTIATED R1's family member (FM) stated that on 11/04/20, the facility called and told FM that R1 needed to go to the hospital due to the resident not eating for 2 weeks. R1's doctor told FM that R1 was severely dehydrated. The 2 caregivers interviewed stated they give water to residents. One of these caregivers stated giving water to residents 4 to 5 times during their shift. LPA reviewed the documents obtained from the facility and the Plan of Care showed R1 came back from the hospital after being treated for UTI. There was no hospital discharge document or other document indicating R1 was dehydrated. LPA tried to obtain records from FM but unsuccessful. Allegation: Staff did not notify responsible party of resident's (R1) change in health condition. - UNSUBSTANTIATED FM stated that the facility did not inform FM that R1 was not eating and positive of COVID-19. R1's doctor told FM on 11/04/20 that R1 was positive of COVID-19. LPA interviewed 4 staff (2 caregivers and 2 care coordinators) who all stated that when there's a change in resident's health condition, med-tech and facility nurse are informed who in-turn assess the resident. The med-tech or the facility nurse notifies the resident's family member. LPA also reviewed the copy of line list showing the names of residents who were tested positive of COVD-19 from 10/23/20 to 11/20/20 submitted by the facility to the Department of Public Health and provided to Community Care Licensing. R1 was not included on the list. Allegation: Facility did not ensure the COVID-19 positive residents were isolated. Six staff (2 caregivers, 2 housekeepers and 2 care coordinators) were interviewed who all stated that residents who tested positive of COVID-19 were isolated. Two of these staff stated that residents in Memory Care, because of dementia, came out of their rooms to the common area. One of these staff also stated that resident who's not positive of COVID-19 comes out to the common area. ....continued on 9099C (page 3) Allegation: Resident (R1) was missing teeth from dentures. - UNSUBSTANTIATED Six staff (2 caregivers, 2 housekeepers and 2 care coordinators) were interviewed who all stated they never heard or observed any resident missing teeth from dentures. Two of these staff stated that residents dentures may gone were missing but were found in the residents clothing. LPA was not able to interview R1 as R1 had passed away prior to the Department receiving the complaint. Allegation: Resident (R1) missing personal property. UNSUBSTANTIATED FM stated that R1's prescription glasses were missing. Six staff (2 caregivers, 2 housekeepers and 2 care coordinators) were interviewed who all stated they never heard any resident missing eyeglasses. One out of 2 residents interviewed stated not losing anything. The other resident stated not losing eyeglasses. LPA was not able to interview R1 as R1 had passed away prior to the Department receiving the complaint. R1's LIC621 Resident Personal Property And Valuables was reviewed which showed eyeglasses not listed. Based on records review and interviews, the 5 allegations are closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there's not a preponderance of evidence to prove that violations occurred. No deficiency cited. The ED authorized Ernesto Buendia to sign and receive this report. Exit interview conducted and copy of this report provided.