Complaint·June 5, 2025

Page 2 It was alleged that when resident’s (R1) family member went to the facility on 5/01/25, the staff was in the shower, and it was resident (R2) who opened the door. HM stated that R1's wife (FM1) was at the facility on 5/01/25 at around 6:30 pm, then left and came back. HM further stated that S3 was in the shower at the time when FM1 came back, and it was R2 who opened the door. S3 confirmed she was by herself and was taking shower and it was R2 who opened the door for FM1. Review of records showed R2 has major neuro cognitive disease and has wandering behavior. Based on interviews and records review, the preponderance standard has been met, therefore, the allegation is substantiated. Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date along with the LIC9098 Proof of Correction form and any repeat violation within 12 month period may result in civil penalty Deficiency and plan and proof of correction were discussed with HM over the phone. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided. Page 2 Allegation: Staff are not providing adequate care and supervision of a resident (R1). It was reported that R1 had fallen out of bed and when FM1 came to the facility on 5/01/25, FM1 found R1 in poor condition and FM1 called 9-11. S1 and S3 stated they were not in the facility when FM1 called 9-11 and R1 was sent out. S1 stated R1 came back the following day. HM stated he talked to FM1 and asked why she wants to call 9-11 and FM1 said R1 does not look good. HM further stated the ambulance came, checked and took R1 vitals and didn't see anything but FM1 insisted to have R1 sent out. FM1 stated she does not have complaint about the care R1 is getting from the facility and that R1 did not fall out of bed. LPA interviewed and verified with RP who stated R1 was diagnosed with weakness and was discharged back to the facility the following. Review of hospital After Visit Summary dated 5/02/25 indicated the following: no admission diagnosis during encounter; no admission procedures for hospital encounters; no comments available. R1 was not able to provide information regarding the incident. Therefore, the allegation is unsubstantiated. Allegation: Staff mishandled a resident. It was alleged that when R1 asked staff to speak English, the staff lifted R1 up by R1’s shirt and put R1 back to bed and that R1 appeared upset. S1 stated that he was getting/preparing and giving R1 morning care when the incident happened. R1 was out balanced and about to fall and his immediate reflex was to catch R1, so he hold R1 onto his shirt to prevent him from falling. S1 denied handling any residents roughly. S1 and S3 also denied handling any residents roughly and stated not observing S1 handled the residents roughly. Three out of 5 residents stated all the staff are nice and never handled them roughly. Due to medical diagnosis, LPA was unable to obtain information from the other 2 residents on how they are handled and/or assisted by the staff. Therefore, the allegation in unsubstantiated. .....continued on 9099C (page 3) Page 3 A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.