complaint·March 27, 2025

In regard to the allegations " Facility staff did not notify responsible party of change in condition " and " Facility staff serve poor quality food "LPA interviewed S3, S4, S5, S6, and Health and Wellnes Director. S3 was not a staff member at the time of R1's admission but stated that the quality of the food is good. S3 described the food as really good. S3 states that the menu choices are good. S3 has eaten the food and says that they are good; sometimes a little bland but nothing that salt and pepper cant fix. S4 stated that the resident never expressed unhappiness to them about anything. States that when resident would complain about the food they would say it sucks and that they would just agree with the resident . States that they have had the food a few times but that it was nothing memorable. S5 states that R1 never expressed any information about their private life. States that the R1 seemed happy. States that R1 would talk about problems with their jobs and going to court with their spouse but that they would be smiling when discussing it. S5 states that they were surprised to find out about R1 incident. States that R1 would complain about the food and quality and that they(S5) would apologize. S5 states that they have tried the food and that they do not like it. States the food is bland, tuff, and greasy. S6 states that they are trained to look for a change in behavior but was unable to specify in regard to mental health. S6 states that they heard about R1's incident and that when looking at the chart they could see that they had a history of depression. However S6 did not ever work with R1. States that it is very common for residents to complain about the food. States that residents complain about the meat being dry and tough. When LPA interviewed HWD they stated that R1 did not exhibit any change in their routine and that when they(R1) were admitted they were already going through stressors and it was not something new that occurred while at the facility. HWD states that R1 was an independent resident and also a private person. R1 would talk about what they were dealing with in life but never expressed being distressed. HWD states that on the day of the incident with R1 there was no change in their routine. HWD states that R1 had a therapist that they would work with and observed R1 utilizing coping mechanisms such as taking walks. Report Continues on LIC9099-C LPA reviewed the 602 for R1 and observed that they did not have a diagnosis of depression and had a secondary diagnosis of anxiety. On 12/16/2024 LPA observed the food being served to the residents and utilized the Business Manager as a taste tester. The food observed was beef stew, rosemary chicken, bbq chicken, lasagna, and carrots. LPA cut each piece and had no difficulty. The business manager sampled each item and stated that they were easy to chew and had a pleasant taste. LPA asked the chef how each item was seasoned and the chef showed the LPA a variety of seasonings and stated that they also used low sodium seasoning. The food looked appetizing and had a pleasant smell. LPA also observed table salt and pepper available at all dining tables for use. On 3/27/2024 LPA briefly spoke with a R3, R4, and R5 during lunch hour who all stated that they like the food at they facility and have no complaints. Based on interviews, observations, and record reviews the allegations are UNSUBSTANTIATED . Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED .