complaint·March 24, 2021

Allegation: Facility not adhering to COVID-19 infection control Based on LPAs’ observations and interviews with 2 reporting parties, the facility failed to adhere to COVID-19 infection protocols. During the onsite initial 10-day complaint visit on 02/22/2021, facility was in COVID-19 outbreak status. The following observations were made: LPAs observed residents not socially distanced while waiting in line in first floor corridor, residents in memory care unit were not socially distanced during group activity, one staff wearing surgical mask pulled down below the mouth in reception area and within 6 feet of a resident, and communal dining and group activities were still being conducted despite local public health recommendation. In addition upon entry of the facility LPAs were not given symptom-check screening questionnaire when checking in at the front desk and LPAs observed pulse oximeter being used on multiple visitors without disinfecting pulse oximeter per use. Allegation: Facility staff do not have required and appropriate training Based on record review Med-tech Staff (S8) and (S12) did not complete eight hours of in-service training on medication-related issues in a 12-month period. Based on LPAs’ observation, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted and Appeal Rights provided. Due to the State's current Shelter in Place Order, a copy of this report was provided by email. THE PAGE IS INTENTIONALLY LEFT BLANK DUE TO DOCUMENT BEING AMENDED. Allegation: Facility failed to administer medication according to doctor's order Based on interviews with 4 residents, 4 out of 4 residents stated that their medications were administered to them according to the scheduled times. Allegation: Facility failed to meet resident’s dietary needs LPAs interviewed a sample of residents who are on a special diet, 2 of 2 residents stated facility is meeting their dietary needs. Staff (S9) said meals are prepared according to resident’s dietary needs indicated on the list. LPAs reviewed records and observed a list of residents with dietary restrictions. Allegation: Biohazardous waste is not properly disposed LPAs interviewed Staff (S8) who stated insulin syringes are disposed in sharp containers in residents' rooms. On 03/20/2021 LPA Allison O'Hollaren (AO) conducted a tele-visit with Staff (S2) and toured two residents' bedrooms. LPA AO observed sharp container with insulin syringes in both resident rooms. Allegation: Uncleared staff working in the facility LPAs collected staff roster and verified that all staff on staff roster have fingerprint clearance. Allegation: Facility failed to notify appropriate parties when resident had a change in condition. Based on progress notes in resident's file, facility did notify appropriate parties when resident had a change in condition. Based on interviews conducted, tele-visit, observations, and records reviewed, LPAs found the above allegations to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Exit interview conducted with Administrator. Copy of report provided via email.