complaint·April 30, 2025

Allegation: Staff did not seek medical attention for resident (R1) in a timely manner. The reporting party stated that R1 sustained laceration to the forehead, and it was still bleeding when Emergency Medical Team (EMT) arrived. RP further stated that R1 had fallen at 8:30am and the facility was delayed in seeking medical attention when R1 had bleeding. W1 stated that W1 came to the facility in the afternoon to attend to R1 who was bleeding when W1 arrived. W1 had to wrap R1’s head to control the bleeding. W1 further stated that the facility called the ambulance when it should be 9-11 that they should call, because R1 fell and was bleeding. LPA reviewed R1’s UIR which showed R1 fell at 8:15 am, was bleeding in the forehead and first aid performed. UIR also confirmed W1’s statement that ambulance was called at 3:00 pm. When LPA interviewed R1, R1 verbalized he was in pain. Based on interviews and records review, the allegation is substantiated. Allegation: Facility has pests. Two out of 3 staff and 2 out of 3 residents interviewed stated observing cockroaches. W1 also stated observing cockroaches in R1’s room. Therefore, the allegation is substantiated. Based on interviews which were conducted, the preponderance of evidence has been met, therefore the above allegations are substantiated. Deficiencies are 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. Deficiencies and plan and proof of corrections were discussed with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided. Allegation: Resident (R1) had an incident while in care. Allegation: Resident (R1) sustained injury while in care. LPA interviewed R1 who was able to verbalized he was pain but unable to provide other information. R2, R3, R4 stated staff are okay. One of the staff interviewed stated not observing other staff being abusive or hurt any of the residents. Review of UIR showed R1 fell on 2/08/22 at the kitchen door in the hallway and sustained injury in the forehead. One of the 3 staff interviewed stated R1 fell near the kitchen. Review of R1’s LIC602A showed that although R1 has dementia but ambulatory. LIC625 did not indicate R1 needed assistance in ambulation. Based on interviews and record review and LPA unable to obtain information from R1 about the incident, the allegations are unsubstantiated. An unsubstantiated findings means that although the allegations may have happened or are valid, the preponderance of evidence standard has not been met. No deficiency cited. Exit interview conducted and copy of this report provided.