complaint·August 5, 2022

Allegation: Staff is not able to communicate effectively with residents Investigation Finding: Unsubstantiated During visit, LPA interviewed staff (S3) in English who stated that she works at the facility every Monday, Wednesday and Friday from 2PM to 5PM. She has worked on call at the facility since September 2020. Her duties include general housekeeping, assisting the 3 residents with showering and grooming as well as doing their laundry. She is bilingual (Spanish and English) and speaks limited English. However, she is able to communicate effectively with residents because one of the residents (R3) speaks Spanish. She stated she also works as a Home Health aide with a Contra Costa County Health agency. LPA observed S3 is able to comprehend English and responds appropriately. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. Allegation: Residents are fed expired food During visit, LPA checked all canned goods in the kitchen and garage cabinets. LPA observed all canned goods were not expired (i.e. Fisha Tuna exp 9/2025; Chef Boyardee Ravioli exp 4/2026; Del Monte Green Beans exp 11/2023; Del Monte Sliced Carrots exp 2/2023; Michigan Made Vegetarian Beans exp 9/2023). LPA interviewed R1 who stated she is not fed expired food. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. Allegation: Facility does not provide activities to the residents Investigation Finding: Unsubstantiated During visit, LPA observed various activity materials at the facility that residents engage in such as large print word puzzle books, Ring Toss, Checkers, Sit & Throw, Caram Board. Administrator stated residents also prefer to enjoy the nice weather in the back porch where they can sit and relax. Residents also watch TV and do sing-a-longs when they feel like it. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. Continued on next page, LIC 9099-C Allegation: Staff falsifies documents Investigation Finding: Unsubstantiated Review of each resident's (R1, R2, & R3) medication administration records from June 2022 to August 2022 show that the prescribed residents' medications were administered and signed by the appropriate staff on duty. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. No deficiencies observed during visit. Exit interview conducted and a copy of this report provided via email.