complaint·July 23, 2024

Lack of care and supervision ­– UNSUBSTANTIATED LPA reviewed medical records for R1 dated 11/28/2022. Per examining physician R1 has a history of severe dementia, is nonverbal at baseline. R1 presented at ER via EMS from Prestige Oroville for being more "altered" than normal. EMS reported that there was mention of R1 having foul smelling urine, but no further information was given. The physician performed a physical exam of R1 and made the following observations: Well-appearing; well-nourished; well-developed; no apparent distress; nontoxic appearance. LPA reviewed incident report dated 11/28/2022 it was reported that R1 was lethargic and not responding to staff. R1 was transported to hospital, diagnosed and treated for UTI and returned to the facility the same day. LPA reviewed medical records dated 04/01/2023 states R1 presented from an assisted living facility memory unit, who was reported to have increased confusion and lethargy and was crying out and hollering which were acute changes in behavior. R1 was sent in for assessment. R1 was found to have a UTI in the emergency room and was admitted for IV antibiotics. LPA reviewed an incident report dated 04/01/2023, it was reported that R1 was lethargic, running a low-grade fever and not responding appropriately to staff. R1 was transported to hospital and their admitting diagnosis was UTI. R1 was hospitalized and treated. LPA reviewed Cal PERS Long Term Care Program Continued monthly residence form for Resident 1 (R1). On 03/31/23 R1 was sent out to hospital. On 04/03/2023 R1 was sent from the hospital to skilled nursing for rehabilitation. On 05/04/2023 R1 returned to the facility from SNF. It was determined that R1 did have re-occurring instances of being treated and / or hospitalized for having a UTI. This does not reach the preponderance of evidence required to substantiate the allegation of lack of care and supervision. This allegation is unsubstantiated. Continued on LIC9099-C Forgery / alteration of document - UNSUBSTANTIATED LPA reviewed a Cal PERS Assignment of Benefits form dated 10/23/2024 which was signed by R1 and the Executive Director. ED stated Cal PERS contacted the facility and said they had not received payment for R1. Cal PERS told ED they were going to send a form and R1 had to sign it. Cal PERS sent the form to the facility and requested the form to be signed by R1 and submitted to Cal PERS. ED stated they told Cal PERS that R1 had dementia and a family member is POA. Cal PERS told the ED that they have to see that R1 is actually there living in the facility. It was determined that the facility was asked to have R1 sign a form and submit it to Cal PERS. ED followed instructions. This allegation is unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report was provided to Executive Director Sonya Gonzales.